Mode of delivery and the risk of delivery-related perinatal death among twins at term: a retrospective cohort study of 8073 births (original) (raw)
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Influence of mode of delivery on neonatal mortality in the second twin, at and before term
BJOG: An International Journal of Obstetrics & Gynaecology, 2008
Objective: To study the association between mode of delivery and neonatal mortality in second twins. To study the association between caesarean delivery and mortality with minimum bias of the indication for the operation, we wanted to compare the outcome of second twins delivered by caesarean due to breech presentation of the sibling with vaginally delivered second twins in uncomplicated pregnancies. Methods: Twins born 1980-2004 were identified from the Swedish Medical Birth Registry. Twin pairs delivered by caesarean due to breech presentation of the first twin, and vaginally delivered twins with the first twin in cephalic presentation were included. Pregnancies with antepartum complications were excluded. Odds ratios (OR) and 95 % confidence intervals (CI) were calculated using multiple logistic regression analyses, adjusting for year of birth, maternal age, parity and gestational age. Results: Compared to second born twins delivered vaginally, second born twins delivered by caesarean (for breech presentation of the sibling) had a lower risk of neonatal death (adjusted OR 0.40; 95% CI 0.19-0.83). The decreased risk after caesarean delivery was significant for births before 34 weeks (2.1% versus 9.0%; adjusted OR 0.40; 95% CI 0.17-0.95). After 34 weeks, neonatal mortality was low in both groups (0.1% and 0.2%, respectively), and the difference was not statistically significant (adjusted OR 0.42; 95% CI 0.10-1.79). Conclusion: Neonatal mortality is lower for the second twin after caesarean delivery at birth before 34 weeks. At term, mortality is low irrespective of delivery mode.
Association of prelabor cesarean delivery with reduced mortality in twins born near term
Obstetrics and gynecology, 2015
To examine short-term and longer-term outcomes for twins born at or near term, comparing prelabor cesarean delivery with birth after a trial of labor. This study was conducted on a retrospective cohort of twin pregnancies delivered at 36 weeks of gestation or greater from 2000 to 2009. Pregnancies with an antenatal death, lethal anomaly, birth weight discordance 25% or more, or birth weight less than 2,000 g or more than 4,000 g were excluded. Outcomes included severe hypoxia, stillbirth and neonatal death, and hospital admissions or death during the first 5 years of life. Approximately 45% of 7,099 twin pregnancies were delivered by prelabor cesarean delivery. Compared with delivery after labor, prelabor cesarean delivery was associated with significantly reduced risks of adverse neonatal and child outcomes including severe birth hypoxia (0.08% compared with 0.75%, relative risk 0.10, 95% confidence interval [CI] 0.04-0.26), neonatal death (0.00% compared with 0.15%, relative risk ...
Obstetrics and gynecology, 2017
To evaluate the association between the planned mode of delivery and neonatal mortality and morbidity in an unselected population of women with twin pregnancies. The JUmeaux MODe d'Accouchement (JUMODA) study was a national prospective population-based cohort study. All women with twin pregnancies and their neonates born at or after 32 weeks of gestation with a cephalic first twin were recruited in 176 maternity units in France from February 2014 to March 2015. The primary outcome was a composite of intrapartum mortality and neonatal mortality and morbidity. Comparisons were performed according to the planned mode of delivery, planned cesarean or planned vaginal delivery. The primary analysis to control for potential indication bias used propensity score matching. Subgroup analyses were conducted, one according to gestational age at delivery and one after exclusion of high-risk pregnancies. Among 5,915 women enrolled in the study, 1,454 (24.6%) had planned cesarean and 4,461 (75...
The impact of mode of delivery on the outcome in very preterm twins
The Journal of Maternal-Fetal & Neonatal Medicine, 2019
Objective Studies on the optimal mode of delivery in women with a twin pregnancy < 32 weeks are scarce. We studied the effects of the mode of delivery on perinatal and maternal outcomes in very preterm twin pregnancy. Design and Setting Population-based cohort study including all women with twin pregnancy who delivered very preterm (26-32 weeks of gestation) in the Netherlands between January 2000 and December 2010. Methods We compared perinatal mortality and neonatal and maternal morbidity according to the intended mode of delivery as well as to the actual mode of delivery. Perinatal outcomes were paired taking into account the dependency between the children of the same twin pregnancy and were also analysed for each child separately. We used logistic regression to correct for possible confounding factors. Results Perinatal mortality was significantly higher in planned caesarean section 22/212 (10.4%) as compared to planned vaginal delivery 94/1443 (6.5%) (aOR 2.5; 95% CI 1.5-4.2) in the whole study population. The same applied for perinatal morbidity 140/212 (66.0%) versus 905/1443 (62.7%) (aOR 1.5; 95% CI 1.1-2.0),maternal morbidity 36/212 (17.0%) versus 71/1443 (4.9%), (aOR 4.0; 95% CI 2.6-6.3) and for perinatal mortality for the second twin 15/212 (7.1%) versus51/1443 (3.5%) (aOR 2.9; 95% CI 1.7-5.2). Conclusion In very preterm delivery of twins a policy of planned caesarean section increases perinatal mortality and neonatal and maternal morbidity.
Cesarean Section for the Second Twin: A Population-Based Study of Occurrence and Outcome
Birth, 2013
Background: Although management of twin deliveries has been a topic of discussion for decades, a consensus on how to deliver twins is lacking. The objective of this study was to examine short-term neonatal outcome of the second twin delivered by cesarean section after vaginal delivery of the first-born twin (combined delivery) and to identify predictors of combined delivery. Methods: This study was a 3-year, population-based, retrospective cohort investigation of 1,254 twin births in Denmark. The twin births were divided into three groups: vaginal deliveries, planned cesarean deliveries, and combined deliveries. Data were extracted from medical records, a fetal medicine software program (Astraia), and the National Birth Registry. Short-term poor neonatal outcome was measured as a 5-minute Apgar score 7, umbilical cord pH 7.10, and admission to neonatal intensive care unit for more than 3 days. Results: Vertex-nonvertex fetal presentations were more prevalent in combined deliveries than vaginal deliveries (OR 4.4, 2.5-7.8). Nonvertex second twins born by combined delivery had a higher risk of Apgar score 7 and umbilical cord pH 7.10 compared with vaginal delivery, unadjusted OR 6.2 (2.1-18), and unadjusted OR 3.9 (1.6-9.5). Prenatal ultrasound scans were evaluated in combined deliveries, of which 48 percent were vertex-vertex at the last ultrasound scan in pregnancy (mean gestational age 34 + 0) and 37 percent were vertex-vertex at birth. Conclusions: Vertex-nonvertex presenting twins have an increased risk of combined delivery. Combined deliveries are associated with increased neonatal morbidity for the second twin. (BIRTH 40:1 March 2013) Management of twin deliveries has been a topic of discussion for decades, yet the lack of randomized trials on the subject still leaves unanswered the question concerning optimal mode of twin delivery. In Denmark, there is a consensus that vaginal delivery may be attempted in women with cephalic presenting twins of similar size, no contraindications to trial of labor, and no intrauterine growth restriction of one or both twins. However, controversy on mode of delivery still remains when the second twin presents as nonvertex.
Cesarean Delivery for the Second Twin
Obstetrics & Gynecology, 2008
Objective-To examine maternal and infant outcomes after a vaginal delivery of twin A and a cesarean delivery of twin B, and to identify whether the second twin experienced increased shortterm morbidity as part of a combined route of delivery.
Clinical indicators associated with the mode of twin delivery: an analysis of 22,712 twin pairs
European journal of obstetrics, gynecology, and reproductive biology, 2015
To identify clinical indicators associated with the planned and actual mode of delivery in women with a twin pregnancy. We performed a retrospective cohort study in women with a twin pregnancy who delivered at a gestational age of 32+0-41+0 weeks and days between 2000 and 2008 in the Netherlands. Data were obtained from a nationwide database. We identified maternal, pregnancy-related, fetal, neonatal and hospital-related indicators that were associated with planned cesarean section (CS) and, for women with planned vaginal delivery (VD), for intrapartum CS. The associations between indicators and mode of delivery were studied with uni- and multivariate logistic regression analyses. We included 22,712 women with a twin pregnancy, of whom 4,310 women (19.0%) had a planned CS. Of the 18,402 women who had a planned VD, 14,034 (76.3%) delivered vaginally, 3,545 (19.3%) had an intrapartum CS, while 823 (4.5%) delivered twin A vaginally and twin B by intrapartum CS. The clinical indicators ...
A Randomized Trial of Planned Cesarean or Vaginal Delivery for Twin Pregnancy
New England Journal of Medicine, 2013
Twin birth is associated with a higher risk of adverse perinatal outcomes than singleton birth. It is unclear whether planned cesarean section results in a lower risk of adverse outcomes than planned vaginal delivery in twin pregnancy. We randomly assigned women between 32 weeks 0 days and 38 weeks 6 days of gestation with twin pregnancy and with the first twin in the cephalic presentation to planned cesarean section or planned vaginal delivery with cesarean only if indicated. Elective delivery was planned between 37 weeks 5 days and 38 weeks 6 days of gestation. The primary outcome was a composite of fetal or neonatal death or serious neonatal morbidity, with the fetus or infant as the unit of analysis for the statistical comparison. A total of 1398 women (2795 fetuses) were randomly assigned to planned cesarean delivery and 1406 women (2812 fetuses) to planned vaginal delivery. The rate of cesarean delivery was 90.7% in the planned-cesarean-delivery group and 43.8% in the planned-vaginal-delivery group. Women in the planned-cesarean-delivery group delivered earlier than did those in the planned-vaginal-delivery group (mean number of days from randomization to delivery, 12.4 vs. 13.3; P=0.04). There was no significant difference in the composite primary outcome between the planned-cesarean-delivery group and the planned-vaginal-delivery group (2.2% and 1.9%, respectively; odds ratio with planned cesarean delivery, 1.16; 95% confidence interval, 0.77 to 1.74; P=0.49). In twin pregnancy between 32 weeks 0 days and 38 weeks 6 days of gestation, with the first twin in the cephalic presentation, planned cesarean delivery did not significantly decrease or increase the risk of fetal or neonatal death or serious neonatal morbidity, as compared with planned vaginal delivery. (Funded by the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT00187369; Current Controlled Trials number, ISRCTN74420086.).
The Australian & New Zealand journal of obstetrics & gynaecology, 2018
To examine the association between inter-twin delivery interval and short-term perinatal outcomes of the second twin after vaginal delivery of the first twin. Retrospective cohort study including twin pregnancies with a vaginal delivery of the first twin between January 2011 and September 2017 in a tertiary hospital in Melbourne, Australia. The main outcome measure was a composite of adverse neonatal outcome (at least one of perinatal death, admission to neonatal intensive care unit (NICU), endotracheal intubation, Apgar <7 at five minutes and cord lactate >4.0 mmol/L). Proportions of adverse outcomes for the second twin were compared between groups of intervals ≤ or >10 and ≤ or >30 min. The composite adverse neonatal outcome occurred in 201 (58.2%) and a caesarean section occurred in seven cases (2%) of the 345 pregnancies included. Delivery interval was associated with higher cord lactate. Low Apgar scores were more frequent with intervals >30 min (17.9% vs 6.6%, P...