Houlihan C, Knuppel R A
Department of Obstetrics and Gynecology, Hahnemann University Hospital, Philadelphia, Pennsylvania, USA.
Clin Perinatol. 1996 Mar;23(1):91-116.
The proper intrapartum management of multiple gestations continues to be debated in the obstetric community. Ultrasonography is key in this management, through its initial assessment of the fetuses in the labor and delivery suite, observations of the second twin after the first has delivered, and its role in external cephalic version. The proper route of delivery requires further investigation for each combination of twin presentations and estimated fetal weights. It is recommended that the nonvertex second twin that is greater than 24 weeks' gestational age and fewer than 1700 g estimated fetal weight should have an attempt made at ECV and, if unsuccessful, a cesarean section should be performed. In the nonvertex second twin weighing greater than 1700 g, ECV or assisted breech extraction is appropriate. It is believed that all triplet gestations should be delivered abdominally. The use of intravenous nitroglycerin for uterine relaxation in multiple gestations is still experimental but may prove to be useful in the abdominal delivery of the nonvertex fetus. Further research is required to elucidate the most critical issues associated with the labor and delivery management of multiple gestations.
多胎妊娠的恰当产时管理在产科领域仍存在争议。超声检查在这种管理中起着关键作用，它可在产房对胎儿进行初步评估，在第一个胎儿娩出后观察第二个胎儿，以及在外倒转术中发挥作用。对于每种双胎胎位和估计胎儿体重的组合，恰当的分娩途径都需要进一步研究。建议对于孕周大于24周且估计胎儿体重小于1700克的非头位第二个胎儿，尝试进行外倒转术，若不成功则应行剖宫产。对于体重超过1700克的非头位第二个胎儿，外倒转术或臀位助产是合适的。人们认为所有三胎妊娠都应经腹分娩。在多胎妊娠中使用静脉注射硝酸甘油来松弛子宫仍处于试验阶段，但可能被证明在非头位胎儿的经腹分娩中有用。需要进一步研究以阐明与多胎妊娠分娩管理相关的最关键问题。
