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Z Geburtshilfe Neonatol 2013; 217(05): 177-182
DOI: 10.1055/s-0033-1357137
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

Rising Cesarean Rates of Twin Deliveries in Germany from 1990 to 2012

Steigende Sektioraten bei Zwillingen in Deutschland von 1990 bis 2012
A. Kyvernitakis
1   Department of Obstetrics and Perinatal Medicine, Phillips University of Marburg, Marburg, Germany
,
I. Kyvernitakis
1   Department of Obstetrics and Perinatal Medicine, Phillips University of Marburg, Marburg, Germany
,
A. S. Karageorgiadis
1   Department of Obstetrics and Perinatal Medicine, Phillips University of Marburg, Marburg, Germany
,
B. Misselwitz
1   Department of Obstetrics and Perinatal Medicine, Phillips University of Marburg, Marburg, Germany
,
G. Papaspyrou
1   Department of Obstetrics and Perinatal Medicine, Phillips University of Marburg, Marburg, Germany
,
M. Kalder
1   Department of Obstetrics and Perinatal Medicine, Phillips University of Marburg, Marburg, Germany
,
S. Schmidt
1   Department of Obstetrics and Perinatal Medicine, Phillips University of Marburg, Marburg, Germany
› Author Affiliations
Further Information

Publication History

received 04 June 2013

accepted after revision 12 September 2013

Publication Date:
29 October 2013 (online)

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Abstract

Background:

In the past 2 decades there has been an increasing trend for cesarean deliveries in twin pregnancies associated with increased maternal and fetal morbidity and mortality.

Methods:

We analyzed the mode of delivery of 18 132 twin gestations from the perinatal survey of Hessen in Germany between 1990 and 2012 and divided them into 4 categories according to the week of gestation (<28, 28–31, 32–36, >36). We further analyzed the cesarean delivery rates for the same period depending on the institutional level and divided them into 3 categories – University hospitals with perinatal center (U/PS), non-university affiliated hospitals with perinatal center (NU/PS) and smaller clinics without perinatal unit (NU/NPS).

Results:

Cesarean rates changed from 63.6% (< 28), 88.9% (28–31), 59.6% (32–36) and 40% (> 36) in the year 1990 to 74.2%, 95.5%, 76.9% and 68.7% in 2012, respectively. As such, we report an overall increase of 23.5% in cesarean deliveries of twins over the last 23 years. We find an overall increase of 16.8%, 21% and 22.1% in university hospitals with perinatal units, in non-university hospitals with perinatal unit and in smaller hospitals without perinatal units, respectively. Furthermore, combined cesareans increased from 3.9% in 1990 to 7.0% in 2012.

Discussion:

These findings indicate a dramatic increase in cesarean delivery rates for twin births from 1990 to 2012. We discuss the importance of international compatible guidelines for the conditions and technical procedures for twin deliveries.

Zusammenfassung

Hintergrund:

Es besteht ein zunehmender Trend zur Schnittentbindung in den letzen 2 Jahrzehnten bei Zwillingsgraviditäten, der mit einer erhöhten Morbidität und Mortalität der Mütter und der Kinder assoziiert ist.

Methoden:

Daten der hessischen Perinatalerhebung wurden benutzt, um die Sektioraten von 18 132 Zwillingsgraviditäten zwischen 1990 und 2012 zu analysieren. Es erfolgte die Einteilung in 4 Gestationsaltersgruppen (< 28, 28–31, 32–36,> 36 Wochen). Außerdem, es wurden die Sektioraten in Abhängigkeit von der institutionellen Ebene analysiert und wurden in 3 Kategorien eingeteilt: Universitätskliniken mit Perinatalzentrum (U/PS), außeruniversitäre Krankenhäuser mit perinatale Einheit (NU/PS) und kleinere Krankenhäuser ohne perinatale Einheit (NU/NPS).

Ergebnisse:

Die Gesamtrate der Kaiserschnitte bei Zwillingen stieg insgesamt um 23,5% in den letzten 23 Jahren. Für Geburten <28, 28–31, 32–36 und >37 SSW stieg die Sektiorate von 63,6%, 88,9%, 59,6% und 40% in 1990 auf 74,2%, 95,5%, 76,9% und 68,7% innerhalb des Beobachtungszeitraums an. Es zeigte sich insgesamt ein Anstieg von 16,8% in Universitätskliniken mit perinatalen Einheiten, 21% in außeruniversitären Krankenhäusern mit perinatalen Einheit und 22,1% in kleineren Krankenhäusern ohne perinatale Einheiten. Zudem stieg die Rate des kombinierten Entbindungsmodus (Sektio beim 2. Zwilling nach vaginaler Entbindung des ersten) von 3,9% in 1990 auf 7,0% in 2012 an.

Diskussion:

Diese Erkenntnisse zeigen einen dramatischen Anstieg der Schnittentbindungen bei Zwillingsgraviditäten zwischen 1990 und 2012. Wir diskutieren die Bedeutung international kompatibler Leitlinien für die Bedingungen und Verfahren für Zwillingsentbindungen.

Key words

cesarean rates - twins - delivery

Schlüsselwörter

Sektiorate - Zwillinge - Entbindung
 

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