Affiliated Maternity and Child Health Care Hospital of Nantong University, Nantong, China.
Medical College of Nantong University, Nantong, China.
Birth. 2023 Dec;50(4):978-987. doi: 10.1111/birt.12737. Epub 2023 Jul 23.
To compare the maternal and neonatal outcomes of twin pregnancies between vertex and nonvertex presentations of the second twin in vaginal delivery.
In this unicentric retrospective cohort study, we collected data from 213 cases of vaginal twin deliveries from January 2016 to July 2020. Participants were divided into the vertex-vertex presentation group (VV) and vertex-breech presentation group (VB). Data on maternal and neonatal outcomes were compared between groups.
Among the 213 mothers and 426 infants (213 twin pairs), there were 140 women in the VV group and 73 women in the VB group (65.73% vs. 34.27%). Infants in the VB group had a higher incidence of admission to NICU (51.43% vs. 68.49%, p = 0.017), lower 1-min (11.43% vs. 28.77%, p < 0.001) and 5-minute Apgar scores (1.43% vs. 4.11%, p = 0.043) for the second twin. However, after the adjustment for sex of the twin, birth weight, chorionicity, and gestational age, the greater risk of admission to NICU and low 5-min Apgar score was no longer significantly different.
VB twins are at no greater overall risk of a poor outcome due to breech presentation in the second twin. However, the presentation of the second fetus represents a risk factor for a low 1-min Apgar score. Obstetricians and midwives should consider appropriate interventions for second twins who present breech versus vertex.
比较阴道分娩中第二胎儿头位与非头位时双胎妊娠的母婴结局。
在这项单中心回顾性队列研究中，我们收集了 2016 年 1 月至 2020 年 7 月期间 213 例阴道分娩双胎的病例数据。参与者分为头对头（VV）组和头臀位（VB）组。比较两组间的母婴结局数据。
在 213 名母亲和 426 名婴儿（213 对双胞胎）中，VV 组有 140 名女性，VB 组有 73 名女性（65.73%比 34.27%）。VB 组婴儿入住新生儿重症监护病房（NICU）的比例更高（51.43%比 68.49%，p=0.017），第二胎儿 1 分钟（11.43%比 28.77%，p<0.001）和 5 分钟 Apgar 评分（1.43%比 4.11%，p=0.043）更低。然而，在调整双胞胎性别、出生体重、绒毛膜性和胎龄后，入住 NICU 的风险增加和 5 分钟 Apgar 评分较低不再有显著差异。
VB 双胞胎中第二胎儿臀位并不会增加整体不良结局的风险。然而，第二胎儿的胎位是 1 分钟 Apgar 评分较低的一个危险因素。产科医生和助产士应考虑对第二胎儿为臀位而非头位的孕妇进行适当的干预。
