双胎妊娠经阴道分娩的母婴结局分析与对策*

目的：探讨双胎妊娠经阴道分娩的母婴安全性，为双胎妊娠分娩方式的选择提供更多参考。方法：收集双胎妊娠选择经阴道试产的孕产妇63例，对母婴结局进行回顾性分析。结果：63例双胎妊娠阴道试产产妇中，成功阴道分娩者55例，阴道分娩成功率87.3%，其中9例经产妇，阴道试产均成功。55例阴道分娩产妇中，孕28～33 +6周39例，34～36+6周11例，37周以上5例，孕周越小，阴道分娩成功率越大；55例成功经阴道分娩产妇中，胎方位为头/头位32例。头/臀位23例。产后出血率9例。阴道分娩新生儿110例，发生窒息16例，新生儿窒息率14.5%。孕周<34周新生儿窒息率13.6%（15/110），孕周≥34周新生儿窒息率0.9%（1/110），孕周<34周的新生儿窒息发生率高于≥34周的新生儿（P<0.05）；第1新生儿窒息发生率3.6%（2/55），第2窒息发生率25.5%（14/55），第2新生儿窒息发生率高于第1新生儿（P<0.01）。结论：双胎妊娠绝非阴道试产的禁忌，分娩方式应根据孕周、胎方位、孕妇的孕产次情况等综合判断，制定个性化的分娩计划，阴道试产过程中加强评估与监护，提高双胎妊娠经阴道分娩的母婴安全。

Study of maternal and infant outcome on vaginal delivery for twin pregnancy

Objective: To explore the safety about the maternal and infant of twin pregnancy to vaginal delivery so as to provide reference about how to choose the delivery mode. Methods: 63 cases of vaginal birth for twin pregnancy were analyzed retrospectively. Results: The success rate was 87.3% (55/63). In the 55 successful cases, 9 multipara pregnancy and 46 primipara pregnancy; the number of cases for different gestational weeks in 28～33 +6 weeks, 34～36+6 weeks and ≥37 weeks were 39, 11and 5 respectively; The cases number of fetal position: head-head and head-breech were 32 and 23; the postpartum hemorrhage rate was 16.4% (9/55). Besides, there were 16 cases(1case≥34 weeks and 15 cases <34 weeks) with the neonatal asphyxia in the 110 newborns; the neonatal asphyxia rate was 14.5%; the neonatal asphyxia rates of the first newborns and the second newborns were 3.6%（2/55）and 25.5%（14/55）. The results showed that the cases of shorter gestational week had higher success rate of vaginal delivery, the neonatal asphyxia incidence in the gestational weeks< 34 weeks was higher than the gestational weeks≥34 weeks clearly (P<0.05), the incidence in the second newborns was higher (P<0.01). Conclusion: Twin pregnancy is not the contraindication to vaginal delivery, the mode of delivery can be determined by gestational weeks, delivery times and fetal position. We should make the personalized delivery plan. Finally the safety about the maternal and infant can be improved by closely monitor to the twin pregnancy women.