Clinical factors affecting the timing of delivery in twin pregnancies
2
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
ObjectiveTo investigate clinical factors affecting the timing of delivery in twin pregnancies in order to minimize perinatal complications. MethodsA retrospective study involved 163 twin pregnancies delivered from January 2006 to September 2011 at Gachon University Gil Medical Center. These cases were divided into three groups based on the delivery timing: less than 32 weeks’ gestation (group A), between 32 and 35+6 weeks’ gestation (group B), and over 36 weeks’ gestation (group C). Clinical factors including maternal age, parity, presence of premature uterine contraction, presence of premature rupture of membrane, white blood cell, high sensitive C-reactive protein level, cervical dilatation, maternal complication, chorionicity, twin specific complication, and perinatal complication were analyzed for each group. ResultsIn group B, the timing of delivery was postponed for 14 days or more from the time of admission, and there were fewer numbers of babies with low Apgar score at birth compared with other groups. The frequency of uterine contraction (P<0.001), presence of premature rupture of membranes (P=0.017), dilatation of cervix (P<0.001), increased white blood cell and high sensitive C-reactive protein levels (P=0.002, P<0.001) were important clinical factors during decision making process of delivery timing in twin pregnancies. Twin specific fetal conditions, such as twin-twin transfusion syndrome and discordant growth (over 25% or more) were shown more frequently in group A. However, there were no significant statistical differences among three groups (P=0.06, P=0.14). ConclusionProper management for preventing premature contraction and inflammation can be essential in twin pregnancies until 32 weeks’ gestation, and may decrease maternal and perinatal complications.
Abstract
ObjectiveTo investigate clinical factors affecting the timing of delivery in twin pregnancies in order to minimize perinatal complications. MethodsA retrospective study involved 163 twin pregnancies delivered from January 2006 to September 2011 at Gachon University Gil Medical Center. These cases were divided into three groups based on the delivery timing: less than 32 weeks’ gestation (group A), between 32 and 35+6 weeks’ gestation (group B), and over 36 weeks’ gestation (group C). Clinical factors including maternal age, parity, presence of premature uterine contraction, presence of premature rupture of membrane, white blood cell, high sensitive C-reactive protein level, cervical dilatation, maternal complication, chorionicity, twin specific complication, and perinatal complication were analyzed for each group. ResultsIn group B, the timing of delivery was postponed for 14 days or more from the time of admission, and there were fewer numbers of babies with low Apgar score at birth compared with other groups. The frequency of uterine contraction (P<0.001), presence of premature rupture of membranes (P=0.017), dilatation of cervix (P<0.001), increased white blood cell and high sensitive C-reactive protein levels (P=0.002, P<0.001) were important clinical factors during decision making process of delivery timing in twin pregnancies. Twin specific fetal conditions, such as twin-twin transfusion syndrome and discordant growth (over 25% or more) were shown more frequently in group A. However, there were no significant statistical differences among three groups (P=0.06, P=0.14). ConclusionProper management for preventing premature contraction and inflammation can be essential in twin pregnancies until 32 weeks’ gestation, and may decrease maternal and perinatal complications.
참고문헌 (21)
- Russell RB, "The changing epidemiology of multiple births in the United States", Obstet Gynecol, 101, pp.129~135 (2003)
- Ghai V, "Morbidity and mortality factors in twins: an epidemiologic approach", Clin Perinatol, 15, pp.123~140 (1988)
- Gardner MO, "The origin and outcome of preterm twin pregnancies", Obstet Gynecol, 85, pp.553~557 (1995)
- Glinianaia SV, "Time trends in twin perinatal mortality in northern England, 1982-94. Northern Region Perinatal Mortality Survey Steering Group", Twin Res, 1, pp.189~195 (1998)
- Alexander GR, "Multiple pregnancy:epidemiology, gestation and perinatal outcome", pp.3~10 (2005), Thompson Publishing Services
- Blickstein I, "Multiple pregnancy: epidemiology, gestation and perinatal outcome" (2005), Taylor & Francis
- Simoes T, "Prospective risk of intrauterine death of monochorionic-diamniotic twins", Am J Obstet Gynecol, 195, pp.134~139 (2006)
- Cleary-Goldman J, "Uncomplicated monochorionic diamniotic twins and the timing of delivery", PLoS Med, 2, pp.e180~ (2005)
- Acosta-Rojas R, "Twin chorionicity and the risk of adverse perinatal outcome", Int J Gynaecol Obstet, 96, pp.98~102 (2007)
- Bajoria R, "The case for routine determination of chorionicity and zygosity in multiple pregnancy", Prenat Diagn, 17, pp.1207~1225 (1997)
- Kalyoncu O, "Neonatal morbidity and mortality of late-preterm babies", J Matern Fetal Neonatal Med, 23, pp.607~612 (2010)
- "Births: final data for 2008" (2010)[URL]
- Fisk NM, "Twin-twin transfusion: as good as it gets?", N Engl J Med, 351, pp.182~184 (2004)
- Assuncao RA, "Perinatal outcome of twin pregnancies delivered in a teaching hospital", Rev Assoc Med Bras, 56, pp.447~451 (2010)
- Gyetvai K, "Tocolytics for preterm labor: a systematic review", Obstet Gynecol, 94(5 Pt 2), pp.869~877 (1999)
- Brubaker SG, "Prediction and prevention of spontaneous preterm birth in twin gestations", Semin Perinatol, 36, pp.190~194 (2012)
- Engstrøm T, "Effect of oxytocin receptor and beta2-adrenoceptor blockade on myometrial oxytocin receptors in parturient rats", Biol Reprod, 60, pp.322~329 (1999)
- Shim JY, "Multicentre, parallel group, randomised, single-blind study of the safety and efficacy of atosiban versus ritodrine in the treatment of acute preterm labour in Korean women", BJOG, 113, pp.1228~1234 (2006)
- Dias T, "Timing of birth in multiple pregnancy", Best Pract Res Clin Obstet Gynaecol, 28, pp.319~326 (2014)
- Kingdom JC, "Discordant growth in twins", Prenat Diagn, 25, pp.759~765 (2005)
- Robinson BK, "Effectiveness of timing strategies for delivery of monochorionic diamniotic twins", Am J Obstet Gynecol, 207, pp.53.e1~53.e7 (2012)