双胎妊娠中第一胎儿与第二胎儿的新生儿结局及分娩方式探讨

Study on the neonatal outcome and delivery ways of first fetus and second fetus in twin pregnancy.

目的探讨双胎妊娠新生儿结局及更好的分娩方式。方法回顾性分析56例双胎妊娠中第一胎儿与第二胎儿的新生儿体重、新生儿窒息率、羊水污染率;分析剖宫产分娩与阴道分娩新生儿窒息率。结果第一胎儿与第二胎儿的体重比较,两组差异无统计学意义(P>0.05)。第一胎儿与第二胎儿新生儿窒息率与羊水污染率比较,第二胎儿新生儿窒息率及羊水污染率均大于第一胎儿窒息率,但差异无统计学意义(P>0.05)。剖宫产组新生儿窒息率明显低于及阴道分娩组(P<0.05)。结论第二胎儿较第一胎儿易发生新生儿窒息,对于第一胎儿为头位、第二胎儿为臀位者选择阴道分娩应慎重,若接产医生没有内倒转或臀位牵引的经验,以剖宫产为宜;对于中等大小的胎儿,两胎均为头位,特别是经产妇时,可选择阴道分娩,其它情况宜选择剖宫产术。

Objective To study the neonatal outcome and the better delivery ways in twin pregnancy. Methods Neonatal weight, the rate of neonatal asphyxia, the rate of amniotic fluid contamination of first fetus and second fetus in 56 twin pregnancy were retrospective analyzed; the neonatal asphyxia rate of cesarean section and vaginal delivery were analyzed. Results There was no significant difference in weight of first fetus and second fetus （P 0.05）. The rate of neonatal asphyxia and amniotic fluid contamination of second fetus both were higher than that of first fetus, but there was no significant difference between the two （P 0.05）. The rate of neonatal asphyxia of cesarean section was much lower than that of vaginal delivery （P 0.05）. Conclusion Neonatal asphyxia of second fetus is tend to occur easier than first fetus, when first fetus is in the position of head presentation, second of breech presentation, vaginal delivery should be chosen carefully, if the doctor have no experience of internal version and breech extraction, cesarean section is more appropriate. For moderately sized fetus and two foetuses both are head presentation, especially to multipara, vaginal delivery should be chosen, else the cesarean section is more appropriate.