剖腹生產或許能預防雙胞胎在生產前後死亡


  Nov. 1, 2002─11月2日最新一期英國醫學期刊(BMJ)中,一篇回顧性質的統計研究結果表示,在自然生產的雙胞胎中,第二個出生的嬰兒因生產過程引發併發症而死亡的風險較第一個出生的嬰兒來得高。蘇格蘭衛生部門(Greater Glasgow Health Board)Gordon C.S. Smith說,因為有太多因為分娩造成雙胞胎中第二個出生嬰兒死亡的案例,因此剖腹生產對雙胞胎嬰兒來說可能較不容易引起週產期死亡。
  
  回顧並分析1992至1997年間於蘇格蘭出生的2,436對雙胞胎記錄,在第36週或36週之後出生的雙胞胎中,第二個出生的嬰兒在週產期死亡的風險明顯增高。沒有任何一個先出生的嬰兒死亡,在第二個出生的嬰兒中卻有9個死亡(P=.004),其中7名是在生產期間發生血氧症死亡,(有5名是因為第一個嬰兒自產道出生後發生技術性問題而引起);然而,在其他454名經剖腹生產的第二個出生嬰兒中,卻沒有任何死亡的案例發生。
  
  第二個出生的雙胞胎嬰兒,其絕對死亡風險整體來說大約為1/270,因生產過程引起血氧症而死的約為1/350,另外1/500的風險為技術問題引起的血氧症;在同時期內的資料看來,這樣的絕對風險比獨生子女還高。
  
  由以上的數據,作者建議,當與懷有雙胞胎的婦女討論生產方式時,必須提醒她們在自然生產的過程中,可能對第二個出生嬰兒所造成的風險,以及剖腹生產的好處。
  
  
  

Caesarean Delivery May Prevent

By Laurie Barclay, MD
Medscape Medical News

Nov. 1, 2002 — Second twins born of vaginal delivery are at higher risk of death than first-born twins from complications during labor and delivery, according to the results of a retrospective cohort study in the Nov. 2 issue of the British Medical Journal.

"Since the excess of deaths of second twins at term seems to be attributable to labor,?如lanned caesarean delivery may be protective against perinatal death among twins," write Gordon C.S. Smith, from the Greater Glasgow Health Board in Scotland, and colleagues.

Records review and analysis of the births of 2,436 twin pairs born in Scotland between 1992 and 1997 revealed significantly increased risks of death during labor and neonatal death among second twins born at or after 36 weeks' gestation. None of the first twins but nine of the second twins died (P=.004). Anoxia during birth caused seven of these deaths, including five deaths related to mechanical problems following vaginal delivery of the first twin. There were no perinatal deaths among 454 second twins delivered at term by planned caesarean section.

The absolute risk of death for second twins born at term was approximately 1 in 270 for all causes, 1 in 350 for death due to anoxia during the birth, and 1 in 500 for anoxic death due to mechanical problems. These absolute risks are high compared with those for singleton term births in Scotland during the same period.

"We propose that women with twins should be counselled about the risk to the second twin and the theoretical possibility of a protective effect of planned caesarean section when considering mode of delivery at term," the authors write.

BMJ. 2002;325:1004-1006

Reviewed by Gary D. Vogin, MD

    
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