Adverse perinatal outcomes related to the delivery mode in women with monochorionic diamniotic twin pregnancies

作者：Yamashita Akiko; Ishii Keisuke^*; Taguchi Takako; Mabuchi Aki; Ota Shiyo; Sasahara Jun; Hayashi Syusaku; Mitsuda Nobuaki

来源：Journal of Perinatal Medicine, 2014, 42(6): 769-775.

DOI：10.1515/jpm-2014-0072

• Acute feto-fetal hemorrhage
• hypoxic ischemic encephalopathy
• monochorionic diamniotic twin
• perinatal outcomes
• trial of labor

Aims: The association between the planned delivery mode and adverse perinatal outcomes of monochorionic diamniotic (MCDA) twin pregnancies at >= 36 weeks' gestation was evaluated.
Methods: This retrospective cohort study included uncomplicated MCDA twin pregnancies delivered after 36 weeks' gestation during a 10-year period. Cases were classified into the trial of labor (TOL) or cesarean section (CS) group according to the planned delivery mode. The primary outcome was a composite of adverse outcomes for at least one twin, including intrauterine fetal death (IUFD) after 36 weeks, neonatal death, umbilical artery pH <7.1, 5-min Apgar scores < 7, hypoxic ischemic encephalopathy (HIE), meconium aspiration syndrome (MAS), respiratory distress syndrome (RDS), or acute feto-fetal hemorrhage (AFFH). The relationship between outcomes and the planned delivery mode was evaluated using a multiple logistic regression analysis.
Results: We included the 310 pregnancies delivered after 36 weeks' gestation. After excluding 15 patients, the final analysis included 295 MCDA pregnancies: 63% had delivered through TOL and 37% through CS. The incidences of composite adverse outcomes in the TOL and CS groups were 4.3% and 1.9%, respectively. No IUFD, neonatal death, MAS, RDS, or AFFH was observed; two infants in each group developed HIE. Adverse outcomes were not significantly associated with any risk factor, including delivery through TOL.
Conclusion: TOL may not influence the perinatal outcomes of MCDA twin pregnancies delivered at >= 36 weeks' gestation.

• 出版日期2014-11