摘要
双胎妊娠的分娩仍是产科最具挑战性的事件。双胎妊娠的分娩时机与分娩方式应根据孕周、当地的医疗条件（产科条件是否为区域性医疗中心、新生儿重症监护病房救治水平等）及母胎的具体情况（绒毛膜性，有无并发症或合并症、复杂双胎等，甚至患者经济情况）等综合考虑，制定适宜的个体化分娩方案。对于无并发症及合并症的双绒毛膜双羊膜囊双胎，38～39^＋6周分娩较适宜；对于无并发症及合并症的单绒毛膜双羊膜囊双胎，适宜的分娩时机为37—38周；复杂性双胎（如单羊膜囊双胎、双胎输血综合征、选择性胎儿生长受限、贫血一红细胞增多序列征、单绒毛膜双胎减胎术或宫内治疗后），需结合孕妇及胎儿的具体情况制定个体化的分娩方案，分娩时机为32～36周。双胎择期剖宫产指征包括单羊膜囊双胎、连体双胎（除外早中孕者）、第一胎非头位、具有单胎的剖宫产指征者，除此之外，均可考虑阴道分娩。
The conduct of a twin delivery remains one of the most challenging events in the daily practice of obstetrics. Timing and mode of delivery of twins should be decided by gestational age, local medical level and maternal - fetal conditions （ complicated twins,cho- rionicity,and so on）,and individualized optimum mode and timing of delivery should be planned.Chorionicity is the most important determinant of pregnancy out- come in twin pregnancy. Induction of labor at 37 to 38 weeks＇ gestation should be routinedly considered in uncomplicated monochorionic twins .Uncomplicated dichorionic twins should be planned between 38 and 39＋6 weeks of gestation. Complicated twins （monoamnionic twins, twin-to-twin transfusion sysdrome, selective intrauterine growth restriction, twin anemia polycythemia sequence） should be planned to havedelivery between 32 and 36 weeks.The indication for planned caesarean section in twin gestations include monoamniotic twins, conjoined twins other than at gestations remote from term, non-vertex twin A,and indications for singleton pregnancies;otherwise the above, planned vaginal delivery should be considered.
出处
《中国实用妇科与产科杂志》
CAS
CSCD
北大核心
2015年第7期617-621,共5页
Chinese Journal of Practical Gynecology and Obstetrics
关键词
双胎妊娠
分娩方式
分娩时机
twin pregnancy
mode of delivery
timing of delivery
