PDF(Pubmed)
Abstract：
UNASSIGNED: Twin pregnancies are associated with higher risks of adverse neonatal outcomes compared to singleton pregnancies. The choice of delivery mode, when twin A presents cephalic, remains a subject of debate. In low- and middle-income countries, where healthcare resources are limited, the decision on the mode of delivery is even more critical.
UNASSIGNED: To evaluate the neonatal outcomes and the hospital costs of planned vaginal delivery compared to cesarean section (CS) in twin pregnancies with twin A presenting cephalic at Tenwek Hospital, Kenya.
UNASSIGNED: This retrospective cohort study analyzed data from all twin deliveries at Tenwek Hospital, Kenya from, April 1, 2017, to March 30, 2023. Maternal data, mode of delivery, and neonatal data were collected from delivery logs, electronic health records, and neonatal records. Neonatal outcomes were a composite of either Appearance, Pulse, Grimace, Activity, and Respiration score less than seven at 5 minutes, neonatal intensive care unit admission, resuscitation, birth trauma, or neonatal complications, including death before discharge from the hospital. A logistic regression model was created to assess the impact of the planned mode of delivery on neonatal outcomes, controlling for antenatal care clinic visits, noncephalic presentation of twin B, and birth weight category.
UNASSIGNED: The study included 177 twin deliveries: 129 (72.9%) were planned as vaginal deliveries and 48 (27.1%) were planned for CS. Among the planned vaginal deliveries, 66 (51.2%) experienced adverse outcomes, compared to 14 (29.2%) in the CS group (P=.009). Logistic regression showed that the odds of adverse outcomes were 0.35 times lower in the CS group compared to the planned vaginal delivery group (95% CI: 0.15-0.83; P=.017). The average total hospital costs for planned vaginal delivery were 104,608 Kenya Shillings (standard deviation 111,761) compared to 100,708 Kenya Shillings (standard deviation 75,468) for CS (P=.82).
UNASSIGNED: Planned cesarean deliveries in twin pregnancies with twin A presenting cephalic at Tenwek Hospital were associated with fewer adverse neonatal outcomes compared to planned vaginal deliveries. There was no significant difference in hospital costs. These findings raise the question of the safest mode of delivery for patients in a resource-constrained setting.
UNASSIGNED: To evaluate the neonatal outcomes and the hospital costs of planned vaginal delivery compared to cesarean section (CS) in twin pregnancies with twin A presenting cephalic at Tenwek Hospital, Kenya.
UNASSIGNED: This retrospective cohort study analyzed data from all twin deliveries at Tenwek Hospital, Kenya from, April 1, 2017, to March 30, 2023. Maternal data, mode of delivery, and neonatal data were collected from delivery logs, electronic health records, and neonatal records. Neonatal outcomes were a composite of either Appearance, Pulse, Grimace, Activity, and Respiration score less than seven at 5 minutes, neonatal intensive care unit admission, resuscitation, birth trauma, or neonatal complications, including death before discharge from the hospital. A logistic regression model was created to assess the impact of the planned mode of delivery on neonatal outcomes, controlling for antenatal care clinic visits, noncephalic presentation of twin B, and birth weight category.
UNASSIGNED: The study included 177 twin deliveries: 129 (72.9%) were planned as vaginal deliveries and 48 (27.1%) were planned for CS. Among the planned vaginal deliveries, 66 (51.2%) experienced adverse outcomes, compared to 14 (29.2%) in the CS group (P=.009). Logistic regression showed that the odds of adverse outcomes were 0.35 times lower in the CS group compared to the planned vaginal delivery group (95% CI: 0.15-0.83; P=.017). The average total hospital costs for planned vaginal delivery were 104,608 Kenya Shillings (standard deviation 111,761) compared to 100,708 Kenya Shillings (standard deviation 75,468) for CS (P=.82).
UNASSIGNED: Planned cesarean deliveries in twin pregnancies with twin A presenting cephalic at Tenwek Hospital were associated with fewer adverse neonatal outcomes compared to planned vaginal deliveries. There was no significant difference in hospital costs. These findings raise the question of the safest mode of delivery for patients in a resource-constrained setting.
摘要：
与单胎妊娠相比，双胎妊娠与新生儿不良结局的风险更高。配送模式的选择,当双胞胎A出现头部时，仍然是一个辩论的主题。在低收入和中等收入国家，在医疗资源有限的地方，交付方式的决定更加关键。
在Tenwek医院评估双胎A头胎儿的双胎妊娠与剖宫产（CS）相比，计划阴道分娩的新生儿结局和住院费用，肯尼亚。
这项回顾性队列研究分析了Tenwek医院所有双胞胎分娩的数据，肯尼亚，2017年4月1日至2023年3月30日。产妇数据，交货方式,新生儿数据是从分娩日志中收集的，电子健康记录,和新生儿记录。新生儿结局是两种外观的复合，脉搏,鬼脸,活动,5分钟时呼吸得分小于7，新生儿重症监护病房入院，复苏,出生创伤,或新生儿并发症，包括出院前的死亡.建立了一个logistic回归模型来评估计划分娩方式对新生儿结局的影响。控制产前护理诊所就诊，双胎B的无头表现，出生体重类别。
■该研究包括177例双胎分娩：129例（72.9%）计划为阴道分娩，48例（27.1%）计划为CS分娩。在计划的阴道分娩中，66（51.2%）出现不良结局，CS组为14（29.2%）（P=.009）。Logistic回归显示，与计划阴道分娩组相比，CS组的不良结局几率低0.35倍（95％CI：0.15-0.83；P=0.017）。计划阴道分娩的平均总医院费用为104,608肯尼亚先令（标准偏差111,761），而CS为100,708肯尼亚先令（标准偏差75,468）（P=.82）。
与计划的阴道分娩相比，在Tenwek医院的双胎妊娠中，双胎A头颅的计划剖宫产分娩与较少的新生儿不良结局相关。住院费用没有显着差异。这些发现提出了在资源有限的情况下患者最安全的分娩方式的问题。
在Tenwek医院评估双胎A头胎儿的双胎妊娠与剖宫产（CS）相比，计划阴道分娩的新生儿结局和住院费用，肯尼亚。
这项回顾性队列研究分析了Tenwek医院所有双胞胎分娩的数据，肯尼亚，2017年4月1日至2023年3月30日。产妇数据，交货方式,新生儿数据是从分娩日志中收集的，电子健康记录,和新生儿记录。新生儿结局是两种外观的复合，脉搏,鬼脸,活动,5分钟时呼吸得分小于7，新生儿重症监护病房入院，复苏,出生创伤,或新生儿并发症，包括出院前的死亡.建立了一个logistic回归模型来评估计划分娩方式对新生儿结局的影响。控制产前护理诊所就诊，双胎B的无头表现，出生体重类别。
■该研究包括177例双胎分娩：129例（72.9%）计划为阴道分娩，48例（27.1%）计划为CS分娩。在计划的阴道分娩中，66（51.2%）出现不良结局，CS组为14（29.2%）（P=.009）。Logistic回归显示，与计划阴道分娩组相比，CS组的不良结局几率低0.35倍（95％CI：0.15-0.83；P=0.017）。计划阴道分娩的平均总医院费用为104,608肯尼亚先令（标准偏差111,761），而CS为100,708肯尼亚先令（标准偏差75,468）（P=.82）。
与计划的阴道分娩相比，在Tenwek医院的双胎妊娠中，双胎A头颅的计划剖宫产分娩与较少的新生儿不良结局相关。住院费用没有显着差异。这些发现提出了在资源有限的情况下患者最安全的分娩方式的问题。
