Objectives:To study modes of delivery and neonatal morbidity of twins as a function of their presentation. Study design:The study related to 614 consecutive patientswho gave birth to twins in the maternity ward of th...Objectives:To study modes of delivery and neonatal morbidity of twins as a function of their presentation. Study design:The study related to 614 consecutive patientswho gave birth to twins in the maternity ward of the Hpital Robert Debréfrom 1992 to 2000. Group A (n = 529) included patients who gave birth after 33 weeks of gestation and group B (n = 85) before 33 weeks. The parameters studied were the mode of delivery,the need for intubation at birth,5-min Apgar score < 9,transfer to intensive care,death in the neonatal period. The chi-square test was used for statistical analysis. Results:In group A,significantly more cesarean sections were performed for breech-breech (22.6%)-and breech-vertex (16%) presentations than for vertex-vertex (10.3%) and vertex-breech (4.6%) presentations. In group B,there was no significant difference in the rate of vaginal delivery. Second vertex twins of group A had significantly higher frequencies of intubation (3%) at birth and transfer to intensive care (3%) than the vertex first twins born by vaginal delivery (p = 0.01). These percentages were not significantly different from those observed for the second twins born by planned Cesarean section before the start of labor (2.8 and 5.6%,respectively). In group B,neonatal parameters did not differ significantly with the type of presentation at delivery. Conclusions:The type of presentation should not influence the choice of mode of delivery of twin pregnancies,whatever the gestational age.展开更多
Objective: To compare digital and ultrasonographic cervical examination for the prediction of preterm delivery in patients hospitalized for preterm labor. Study design: Fiftynine patients were included. The Bishop s...Objective: To compare digital and ultrasonographic cervical examination for the prediction of preterm delivery in patients hospitalized for preterm labor. Study design: Fiftynine patients were included. The Bishop score was evaluated upon admission, weeks gestational age. Ultrasonographic measurement of cervical length was done within 24 h after entry. Delivery before 37 weeks gestational age was the primary endpoint. Attending obstetricians were blinded to the results of echography. Results: Preterm delivery rate was 39%(23/59). The risk of preterm delivery was significantly increased when the Bishop score was greater than or equal to 6 (OR=4.45 [1.41-14.01]) or when ultrasonographic cervical length was less than or equal to 27 mm (OR=4.04 [1.32-12.3]), but digital examination was the only independent risk factor in multivariate analysis. Sensitivity, specificity, positive and negative predictive value for digital examination and ultrasonography were respectively 74, 61, 55 and 79%, 70, 64, 55 and 77%. Combination of digital examination and ultrasonography did not yield better results. Conclusion: In our series, prediction of preterm delivery was not improved by ultrasonography compared to digital examination. The size of the cervical shift observed in most patients hospitalized for preterm labor may render ultrasonography less relevant in identifying patients anticipated to deliver prematurely.展开更多
文摘Objectives:To study modes of delivery and neonatal morbidity of twins as a function of their presentation. Study design:The study related to 614 consecutive patientswho gave birth to twins in the maternity ward of the Hpital Robert Debréfrom 1992 to 2000. Group A (n = 529) included patients who gave birth after 33 weeks of gestation and group B (n = 85) before 33 weeks. The parameters studied were the mode of delivery,the need for intubation at birth,5-min Apgar score < 9,transfer to intensive care,death in the neonatal period. The chi-square test was used for statistical analysis. Results:In group A,significantly more cesarean sections were performed for breech-breech (22.6%)-and breech-vertex (16%) presentations than for vertex-vertex (10.3%) and vertex-breech (4.6%) presentations. In group B,there was no significant difference in the rate of vaginal delivery. Second vertex twins of group A had significantly higher frequencies of intubation (3%) at birth and transfer to intensive care (3%) than the vertex first twins born by vaginal delivery (p = 0.01). These percentages were not significantly different from those observed for the second twins born by planned Cesarean section before the start of labor (2.8 and 5.6%,respectively). In group B,neonatal parameters did not differ significantly with the type of presentation at delivery. Conclusions:The type of presentation should not influence the choice of mode of delivery of twin pregnancies,whatever the gestational age.
文摘Objective: To compare digital and ultrasonographic cervical examination for the prediction of preterm delivery in patients hospitalized for preterm labor. Study design: Fiftynine patients were included. The Bishop score was evaluated upon admission, weeks gestational age. Ultrasonographic measurement of cervical length was done within 24 h after entry. Delivery before 37 weeks gestational age was the primary endpoint. Attending obstetricians were blinded to the results of echography. Results: Preterm delivery rate was 39%(23/59). The risk of preterm delivery was significantly increased when the Bishop score was greater than or equal to 6 (OR=4.45 [1.41-14.01]) or when ultrasonographic cervical length was less than or equal to 27 mm (OR=4.04 [1.32-12.3]), but digital examination was the only independent risk factor in multivariate analysis. Sensitivity, specificity, positive and negative predictive value for digital examination and ultrasonography were respectively 74, 61, 55 and 79%, 70, 64, 55 and 77%. Combination of digital examination and ultrasonography did not yield better results. Conclusion: In our series, prediction of preterm delivery was not improved by ultrasonography compared to digital examination. The size of the cervical shift observed in most patients hospitalized for preterm labor may render ultrasonography less relevant in identifying patients anticipated to deliver prematurely.
