Omondi Fred O, Murphy Meghan K, Stark Moselle M, Cowles Cheryl B, Greig Phillip C, Ndikumana Benoît J, Parker Robert K
Department of Obstetrics and Gynecology, Tenwek Hospital, Bomet, Kenya (Omondi, Murphy, Stark, Cowles, and Greig).
Department of Obstetrics and Gynecology, Maua Methodist Hospital, Meru, Kenya (Ndikumana).
AJOG Glob Rep. 2024 Jun 18;4(3):100370. doi: 10.1016/j.xagr.2024.100370. eCollection 2024 Aug.
Twin pregnancies are associated with higher risks of adverse neonatal outcomes compared to singleton pregnancies. The choice of delivery mode, when twin A presents cephalic, remains a subject of debate. In low- and middle-income countries, where healthcare resources are limited, the decision on the mode of delivery is even more critical.
To evaluate the neonatal outcomes and the hospital costs of planned vaginal delivery compared to cesarean section (CS) in twin pregnancies with twin A presenting cephalic at Tenwek Hospital, Kenya.
This retrospective cohort study analyzed data from all twin deliveries at Tenwek Hospital, Kenya from, April 1, 2017, to March 30, 2023. Maternal data, mode of delivery, and neonatal data were collected from delivery logs, electronic health records, and neonatal records. Neonatal outcomes were a composite of either Appearance, Pulse, Grimace, Activity, and Respiration score less than seven at 5 minutes, neonatal intensive care unit admission, resuscitation, birth trauma, or neonatal complications, including death before discharge from the hospital. A logistic regression model was created to assess the impact of the planned mode of delivery on neonatal outcomes, controlling for antenatal care clinic visits, noncephalic presentation of twin B, and birth weight category.
The study included 177 twin deliveries: 129 (72.9%) were planned as vaginal deliveries and 48 (27.1%) were planned for CS. Among the planned vaginal deliveries, 66 (51.2%) experienced adverse outcomes, compared to 14 (29.2%) in the CS group (=.009). Logistic regression showed that the odds of adverse outcomes were 0.35 times lower in the CS group compared to the planned vaginal delivery group (95% CI: 0.15-0.83; =.017). The average total hospital costs for planned vaginal delivery were 104,608 Kenya Shillings (standard deviation 111,761) compared to 100,708 Kenya Shillings (standard deviation 75,468) for CS (=.82).
Planned cesarean deliveries in twin pregnancies with twin A presenting cephalic at Tenwek Hospital were associated with fewer adverse neonatal outcomes compared to planned vaginal deliveries. There was no significant difference in hospital costs. These findings raise the question of the safest mode of delivery for patients in a resource-constrained setting.
与单胎妊娠相比，双胎妊娠出现不良新生儿结局的风险更高。当双胎中的A胎儿为头先露时，分娩方式的选择仍是一个有争议的话题。在医疗资源有限的低收入和中等收入国家，分娩方式的决策更为关键。
评估在肯尼亚滕韦克医院，双胎中的A胎儿为头先露的双胎妊娠中，计划阴道分娩与剖宫产相比的新生儿结局和住院费用。
这项回顾性队列研究分析了2017年4月1日至2023年3月30日期间在肯尼亚滕韦克医院所有双胎分娩的数据。从分娩记录、电子健康记录和新生儿记录中收集产妇数据、分娩方式和新生儿数据。新生儿结局是一个综合指标，包括5分钟时阿氏评分低于7分、新生儿重症监护病房入院、复苏、产伤或新生儿并发症，包括出院前死亡。创建了一个逻辑回归模型来评估计划分娩方式对新生儿结局的影响，并控制产前检查次数、双胎中的B胎儿非头先露情况和出生体重类别。
该研究包括177例双胎分娩：129例（72.9%）计划阴道分娩，48例（27.1%）计划剖宫产。在计划阴道分娩的产妇中，66例（51.2%）出现不良结局，而剖宫产组为14例（29.2%）（P =.009）。逻辑回归显示，与计划阴道分娩组相比，剖宫产组不良结局的几率低0.35倍（95%置信区间：0.15 - 0.83；P =.017）。计划阴道分娩的平均总住院费用为104,608肯尼亚先令（标准差111,761），而剖宫产为100,708肯尼亚先令（标准差75,468）（P =.82）。
在滕韦克医院，双胎中的A胎儿为头先露的双胎妊娠中，计划剖宫产与计划阴道分娩相比，不良新生儿结局更少。住院费用无显著差异。这些发现引发了在资源有限环境下患者最安全分娩方式的问题。
