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双子分娩における真空抜去-母体および新生児期の結果:レトロスペクティブコホート研究
Vacuum extraction in twin deliveries-maternal and neonatal consequences: a retrospective cohort study.
PMID: 32643042 DOI: 10.1007/s00404-020-05668-2.
抄録
目的:
双子妊娠の分娩患者における真空分娩の頻度を確立し、危険因子と周産期転帰を明らかにする。
PURPOSE: To establish the frequency of vacuum extraction among parturients with twin pregnancies, identify the risk factors and perinatal outcomes.
方法:
2005年から2018年の間にレトロスペクティブなコホートデータベース研究を実施した。妊娠34週以上で経膣分娩を達成した頂点提示のある双胎児を対象とした。アウトカムは、真空採血で分娩された新生児と自然分娩で分娩された新生児の間で比較された(aORs; [95% CI])。
METHODS: A retrospective cohort database study was conducted between 2005-2018. Twin fetuses with vertex presentation >34 weeks gestation who achieved vaginal delivery were included. Outcomes were compared between neonates who were delivered by vacuum extraction and neonates delivered by spontaneous vaginal delivery (aORs; [95% CI]).
結果:
双胎妊娠の分娩者905人の新生児合計1751人が包含基準を満たし、そのうち163人(18%)の分娩者が真空抜去を受け、225人(12.8%)の新生児が真空抜去で分娩された。真空摘出の最も有意な危険因子は、プライマリー(6.79[4.77-9.66])、過去の帝王切開分娩(5.59[3.13-9.97])、および硬膜外鎮痛(4.34[1.83-10.31])であった。真空摘出は、特に産後出血とその関連する病的障害(2.60 [1.61-4.19])、母体の有害な転帰のスペクトルと関連していた。新生児の面では、真空引き分娩は出生時の外傷の複合体と関連していた(21.81 [6.43-73.91])。
RESULTS: A total of 1751 neonates of 905 parturients with twin pregnancies met inclusion criteria, of which 163 (18%) parturients had vacuum extraction and 225 (12.8%) neonates were delivered by vacuum extraction. The most significant risk factors for vacuum extraction were primiparity (6.79 [4.77-9.66]), previous cesarean delivery (5.59 [3.13-9.97]), and epidural analgesia (4.34 [1.83-10.31]). Vacuum extractions were associated with a spectrum of adverse maternal outcomes (2.60 [1.61-4.19]), particularly postpartum hemorrhage and its associated morbidities. From the neonatal aspect, vacuum extraction deliveries were associated with a composite of birth trauma injuries (21.81 [6.43-73.91]).
結論:
双子妊娠中の真空引きは、産後出血、輸血、周産期出生外傷の有意に高い率と関連していることが判明した。これらの知見は、分娩方法についてカウンセリングを行う際に女性に提示し、帝王切開分娩の不利な点を考慮して個別に検討すべきである。
CONCLUSION: Vacuum extractions among twin pregnancies were found to be associated with significantly higher rates of postpartum hemorrhage, blood transfusion, and perinatal birth trauma. These findings should be presented to women when counseling on mode of delivery and considered individually against cesarean delivery disadvantages.