Mauldin J G, Newman R B, Mauldin P D
Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston 29425, USA.
Am J Obstet Gynecol. 1998 Oct;179(4):864-9. doi: 10.1016/s0002-9378(98)70179-6.
The aim of the study was to determine the most cost-effective delivery management of vertex and nonvertex twin pair gestations.
Two hundred sixty-six consecutive twin gestations were followed up prospectively in a special antepartum Twins Clinic directed by the Maternal-Fetal Medicine Division. Maternal demographic, obstetric, and neonatal data were compiled prospectively. Information regarding 84 vertex and nonvertex twin pair gestations was extracted for review. Comparison groups included 41 twin pairs managed by spontaneous vaginal delivery and breech extraction (group A), 19 twin pairs managed by spontaneous vaginal delivery and external cephalic version (group B), and 24 twin pairs managed by primary cesarean delivery (group C). In-hospital financial data were retrieved and adjusted for inflation to 1996 constant dollars (data from a single institution allow comparison of charges). The Kruskal-Wallis chi2 test, the Fisher exact test, and analysis of variance were used for statistical analysis.
The 3 groups did not differ with respect to maternal demographics, medical complications, gestational age, birth weight, fetal sex, or intrauterine growth restriction. Maternal and neonatal hospital charges were both significantly lower (P = .01 and P = .0001, respectively) in the breech extraction group A ($5890 +/- $2304 and $3526 +/- $5017, respectively) than in either group B ($8638 +/- $4175 and $11,754 +/- $15,457, respectively) or group C ($7,608 +/- $3,256 and $36,994 +/- $54,318, respectively). Although maternal morbidity was similar among the 3 groups, length of stay was shorter for mothers in group A. The infants delivered by spontaneous vaginal delivery and breech extraction (group A) had significantly lower rates of pulmonary disease (7% vs 24% vs 31% for groups A, B, and C, respectively; P = .002) and neonatal infectious disease (1% vs 0% vs 16%; P = .0005). These infants required the use of a ventilator less frequently (5% vs 12% vs 24%; P = .01), were more likely to be admitted to the normal newborn nursery (71% vs 51% vs 50%; P = .0001), and had a significantly shorter length of hospitalization (4.8 vs 12.4 vs 17.8 days; P = .0001).
There is no medical consensus regarding delivery management for vertex and nonvertex presenting twin pairs. When hospital charges are examined with clinical data, however, breech extraction of the nonvertex second twin is the most cost-effective delivery management strategy.
本研究旨在确定头位和非头位双胎妊娠最具成本效益的分娩管理方式。
在母胎医学科主管的一个特殊产前双胎诊所对266例连续双胎妊娠进行前瞻性随访。前瞻性收集产妇人口统计学、产科和新生儿数据。提取84例头位和非头位双胎妊娠的信息进行回顾。比较组包括41例经自然阴道分娩和臀位牵引术处理的双胎（A组）、19例经自然阴道分娩和外倒转术处理的双胎（B组）以及24例经初次剖宫产处理的双胎（C组）。检索住院财务数据并根据通货膨胀调整为1996年不变美元（来自单一机构的数据可比较费用）。采用Kruskal-Wallis卡方检验、Fisher精确检验和方差分析进行统计分析。
三组在产妇人口统计学、医学并发症、孕周、出生体重、胎儿性别或胎儿生长受限方面无差异。臀位牵引术的A组产妇和新生儿住院费用均显著低于B组（分别为5890±2304美元和8638±4175美元，以及35
