[双胞胎的分娩:从国家观察前性比较研究JUMODA中吸取的经验教训]
Thomas Schmitz1, François Goffinet2
1Service de Gynécologie Obstétrique, Hôpital Robert Debré, Assistance Publique - Hôpitaux de Paris, 48, boulevard Sérurier, 75019 Paris, France; Inserm UMR 1153, Équipe de Recherche en Épidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Centre de Recherche en Épidémiologie et Statistique Sorbonne Paris Cité, Paris, France; Université Paris Cité, Paris, France.
Gynecologie, obstetrique, fertilite & senologie
|November 23, 2023
概括
对于大多数双胞胎怀孕,建议计划性阴道分娩,提供与剖腹产相比的新生儿结果. 第二个双胞胎的管理.
科学领域:
- 产科和妇科 产科和妇科
- 孕产妇和胎儿医学 孕产妇和胎儿医学
- 新生儿科学 新生儿科学
背景情况:
- 双胞胎怀孕带来了独特的分娩挑战,需要基于证据的分娩方式和第二个双胞胎管理指南.
- 该JUMODA (JUmeaux MODE d'Accouchement) 研究旨在通过比较基于计划分娩方法的结果提供此类证据.
研究的目的:
- 为了在双胞胎怀孕中比较计划剖腹产和计划阴道分娩之间的新生儿和孕产妇发病率.
- 确定最佳的管理策略,以提供第二个双胞胎,以改善新生儿的结果.
主要方法:
- 一项全国性的前性,观察性,比较性研究 (JUMODA) 在法国176个产科单位进行.
- 这项研究涉及8823名女性,她们在怀孕22周或更长的时间内分娩双胞胎.
- 利用多变量后勤回归和倾向得分匹配以控制混因素.
主要成果:
- 对于双胞胎怀孕的头部第一双胞胎 (妊娠≥32周),计划的剖腹产与计划性阴道分娩 (2.2%) 相比,与更高的重症新生儿发病率 (5.2%) 相关.
- 计划剖腹产的风险增加主要是由于早产新生儿的严重发病率较高.
- 计划性阴道分娩没有增加后头双胞胎 (32周后) 或早产早产 (<32周后) 的风险. 脑膜第二双胞胎的管理没有显著影响新生儿发病率.
结论:
- 在大多数双胞胎怀孕中,应鼓励计划性阴道分娩,无论第一个双胞胎的表现或妊娠年龄如何.
- 目前的证据不支持对脑膜第二双胞胎的特定管理策略;选择取决于临床医生的偏好.
关键词:
双胞胎的出生时间第二个双胞胎的分娩第二个双胞胎的交付.这是一个巨大的开采 de siège.内部头脑版本的内部头脑版本计划的交付方式.总的尾部提取总量双胞胎送货 双胞胎送货 双胞胎送货计划生育方式的分娩.版本是通过内部操作.更多相关视频
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