Выяснен оптимальный срок родов для беременных двойнями
16 сентября 2016
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№152, сентябрь 2016 Врач
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Выяснен оптимальный срок родов для беременных двойнями
Хорошо известно, что риск мертворождения при беременности двойней нарастает с каждой неделей гестации. Поэтому акушеры-гинекологи часто выбирают тактику раннего родоразрешения таких женщин. Однако при раннем родоразрешении увеличивается риск неонатальной смертности новорожденных (в первые 28 суток после рождения). Задачей ученых было найти оптимальный срок родоразрешения, при котором риск мертворождения и риск неонатальной смертности будут сбалансированы и минимальны.
Международная группа ученых проанализировала результаты 32 исследований за последние 10 лет. Исследования содержали сведения о мертворождениях и неонатальной смертности при беременностях двойнями. В общей сложности учитывалась 35 171 беременность двойнями (29 685 дихориальных беременностей, т. е. с двумя плацентами, и 5 486 монохориальных, т. е. с одной плацентой). Для дихориальной беременности риски были сбалансированы на 37‑й неделе беременности.
Откладывание родоразрешения на неделю — до 38‑й недели — приводило к увеличению смертей на 8,8 ребенка на 1000 за счет роста мертворождений. При монохориальной беременности риск мертворождения превышал риск смерти в неонатальном периоде уже после 36‑й недели беременности. Риски неонатальной смертности (включая респираторный дистресс-синдром, сепсис, судороги) и пребывания в неонатологической реанимации постоянно убывали с увеличением срока гестации при моно- и дихориальных беременностях.
Авторы исследования делают следующий вывод: родоразрешение при дихориальной беременности необходимо проводить на 37‑й неделе. Для монохориальной беременности — нет четких доказательств того, что родоразрешение нужно проводить до 36‑й недели.
Источники:
sciencedaily.combmj.com (PDF)
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