Abstract：
OBJECTIVE: To review current international clinical guidelines on the antenatal and intrapartum management of twin pregnancies, examining areas of consensus and conflict.
METHODS: We conducted a database search using Medline, Pubmed, Scopus, Academic Search Complete, CINAHL and ERCI Guidelines website. Guidelines were screened for eligibility using our inclusion and exclusion criteria. Those deemed eligible were quality assessed using the AGREE II tool and relevant data was extracted.
RESULTS: We identified 21 relevant guidelines from 16 countries including two international society guidelines. There was consensus in determination of chorionicity and amnionicity within the first trimester, fetal anomaly scan between 18 and 22 weeks and the recommended screening for twin-to-twin transfusion syndrome (TTTS). For those that provided intrapartum guidance, there was agreement in recommending caesarean section to deliver monochorionic monoamniotic (MCMA) twins, epidural anaesthesia for intrapartum analgesia and the use of cardiotocography (CTG) for intrapartum fetal monitoring. The main areas of conflict included cervical length screening, frequency of ultrasound surveillance, timing of delivery of dichorionic twin pregnancies and circumstances for recommending vaginal delivery. There was a lack of advice on intrapartum management.
CONCLUSIONS: This review has highlighted the need for unified international guidance on the management of twin pregnancy. Comparisons of current guidance demonstrates a lack of confidence in the management of labour in twin pregnancies. Further evidence on intrapartum care of twin pregnancies is needed to inform practice guidelines and improve both short and long term maternal and fetal outcomes.
METHODS: We conducted a database search using Medline, Pubmed, Scopus, Academic Search Complete, CINAHL and ERCI Guidelines website. Guidelines were screened for eligibility using our inclusion and exclusion criteria. Those deemed eligible were quality assessed using the AGREE II tool and relevant data was extracted.
RESULTS: We identified 21 relevant guidelines from 16 countries including two international society guidelines. There was consensus in determination of chorionicity and amnionicity within the first trimester, fetal anomaly scan between 18 and 22 weeks and the recommended screening for twin-to-twin transfusion syndrome (TTTS). For those that provided intrapartum guidance, there was agreement in recommending caesarean section to deliver monochorionic monoamniotic (MCMA) twins, epidural anaesthesia for intrapartum analgesia and the use of cardiotocography (CTG) for intrapartum fetal monitoring. The main areas of conflict included cervical length screening, frequency of ultrasound surveillance, timing of delivery of dichorionic twin pregnancies and circumstances for recommending vaginal delivery. There was a lack of advice on intrapartum management.
CONCLUSIONS: This review has highlighted the need for unified international guidance on the management of twin pregnancy. Comparisons of current guidance demonstrates a lack of confidence in the management of labour in twin pregnancies. Further evidence on intrapartum care of twin pregnancies is needed to inform practice guidelines and improve both short and long term maternal and fetal outcomes.
摘要：
目的：回顾目前国际上双胎妊娠产前和产时管理的临床指南，审查共识和冲突领域。
方法：我们使用Medline进行了数据库搜索，Pubmed,Scopus,学术搜索完成，CINAHL和ERCI指南网站。使用我们的纳入和排除标准筛选指南的资格。使用AGREEII工具对那些被认为合格的人进行质量评估，并提取相关数据。
结果：我们确定了来自16个国家的21个相关指南，其中包括两个国际社会指南。在妊娠早期的绒毛膜性和羊膜性的测定上有共识，在18-22周之间进行胎儿异常扫描，并推荐筛查双胎至双胎输血综合征（TTTS）。对于那些提供产时指导的人，建议剖腹产分娩单绒毛膜单羊膜（MCMA）双胞胎，硬膜外麻醉用于产时镇痛和使用心肌造影（CTG）用于产时胎儿监测。冲突的主要领域包括子宫颈长度筛查，超声监测的频率，双胎双胎妊娠的分娩时间和推荐阴道分娩的情况。缺乏关于产时管理的建议。
结论：本综述强调了双胎妊娠管理需要统一的国际指南。对当前指南的比较表明，对双胎妊娠的分娩管理缺乏信心。需要进一步的证据来证明双胎妊娠的产时护理，以指导实践指南并改善短期和长期的母婴结局。
方法：我们使用Medline进行了数据库搜索，Pubmed,Scopus,学术搜索完成，CINAHL和ERCI指南网站。使用我们的纳入和排除标准筛选指南的资格。使用AGREEII工具对那些被认为合格的人进行质量评估，并提取相关数据。
结果：我们确定了来自16个国家的21个相关指南，其中包括两个国际社会指南。在妊娠早期的绒毛膜性和羊膜性的测定上有共识，在18-22周之间进行胎儿异常扫描，并推荐筛查双胎至双胎输血综合征（TTTS）。对于那些提供产时指导的人，建议剖腹产分娩单绒毛膜单羊膜（MCMA）双胞胎，硬膜外麻醉用于产时镇痛和使用心肌造影（CTG）用于产时胎儿监测。冲突的主要领域包括子宫颈长度筛查，超声监测的频率，双胎双胎妊娠的分娩时间和推荐阴道分娩的情况。缺乏关于产时管理的建议。
结论：本综述强调了双胎妊娠管理需要统一的国际指南。对当前指南的比较表明，对双胎妊娠的分娩管理缺乏信心。需要进一步的证据来证明双胎妊娠的产时护理，以指导实践指南并改善短期和长期的母婴结局。
