Fishman A, Grubb D K, Kovacs B W
Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles.
Am J Obstet Gynecol. 1993 Mar;168(3 Pt 1):861-4. doi: 10.1016/s0002-9378(12)90834-0.
The purpose of our study was to test the hypothesis that there is no increased morbidity or mortality associated with vaginal delivery of the nonvertex second twin.
The medical records of 781 consecutive twin gestations achieving a gestational age > or = 20 weeks and delivering between Jan. 1, 1985, and Dec. 31, 1988, were reviewed. All live-born, vaginally delivered second twins were identified, grouped by presentation, and compared with respect to 5-minute Apgar scores, length of neonatal hospital stay, neonatal intensive care unit admissions, and neonatal deaths.
Of the 390 live-born, vaginally delivered second twins, 207 were delivered as vertex and 183 were delivered as breech. Ninety-five percent of the breech deliveries were total breech extractions. There were no statistically significant differences between the vaginal breech and vaginal vertex deliveries in any of the neonatal outcome measures studied even when stratified by birth weight.
These results support the null hypothesis and suggest that vaginal delivery of the nonvertex second twin is a safe intrapartum management option, although no conclusion can be reached in infants weighing < 1500 gm. We found no evidence of excessive morbidity or mortality associated with total breech extraction of the second twin.
我们研究的目的是检验以下假设，即非头位第二胎儿经阴道分娩不会增加发病率或死亡率。
回顾了1985年1月1日至1988年12月31日期间781例孕周≥20周且分娩的连续双胎妊娠的病历。确定所有经阴道分娩的存活第二胎儿，按胎位分组，并比较其5分钟阿氏评分、新生儿住院时间、新生儿重症监护病房收治情况及新生儿死亡情况。
在390例经阴道分娩的存活第二胎儿中，207例为头位分娩，183例为臀位分娩。95%的臀位分娩为完全臀位牵引。在所研究的任何新生儿结局指标中，即使按出生体重分层，阴道臀位分娩和阴道头位分娩之间也没有统计学上的显著差异。
这些结果支持原假设，并表明非头位第二胎儿经阴道分娩是一种安全的产时管理选择，尽管对于体重<1500克的婴儿无法得出结论。我们没有发现与第二胎儿完全臀位牵引相关的过高发病率或死亡率的证据。
