Association of prelabor cesarean delivery with reduced mortality in twins born near term (original) (raw)
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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...
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.
Neonatal morbidity in second twin according to gestational age at birth and mode of delivery
American Journal of Obstetrics and Gynecology, 2004
Objective: This study was undertaken to assess the risk of neonatal morbidity in the second twins. Study design: We carried out a cohort study of 128,219 live born second twins in the United States, 1995 through 1997. The study subjects were divided into 3 groups: second twins delivered by cesarean section after vaginal delivery of the first twin (V-C), both twins delivered vaginally (V-V), and both twins delivered by cesarean section (C-C). Results: The rates of low 5-minute Apgar score, mechanical ventilation, and seizure were higher in the V-C group (8.27%, 13.39%, and 0.31%) than in the V-V (3.07%, 7.51%, and 0.08%) and the C-C (2.66%, 8.53%, and 0.06%) groups. The V-C associated increase in risk remained after adjustment for confounding factors and was more evident at term than preterm. Conclusion: The risk of neonatal morbidity is increased in second twins who had a cesarean section after vaginal delivery of the first twin, especially at term.
American Journal of Obstetrics and Gynecology, 2012
We sought to assess neonatal morbidity and mortality of elective cesarean section (CS) of uncomplicated twin pregnancies per week of gestation >35(+0). We performed a retrospective cohort study in our nationwide database including all elective CS of twin pregnancies. Two main composite outcome measures were defined, ie, severe adverse neonatal outcome and mild neonatal morbidity. We report on 2228 neonates. More than 17% were born <37(+0) weeks of gestation. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for severe adverse neonatal outcome at 35(+0-6), 36(+0-6), and 37(+0-6) weeks were, OR, 9.4; 95% CI, 3.2-27.6; OR, 1.7; 95% CI, 0.5-5.3; and OR, 0.7; 95% CI, 0.2-2.0, respectively; and for mild neonatal morbidity, OR, 4.7; 95% CI, 2.6-8.7; OR, 4.9; 95% CI, 3.1-7.9; and 1.4; 95% CI, 0.9-2.1, respectively, compared to neonates born ≥38(+0) weeks of gestation. In uncomplicated twin pregnancies elective CS can best be performed between 37(+0) and 39(+6) weeks of gestation.
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.
Journal of perinatology : official journal of the California Perinatal Association, 2014
To examine trends for preterm births, stillbirths, neonatal and infant deaths in twin births by gestational age and birth weight categories, as well as trends in induction of labor and cesarean delivery during 1995-2006. A trend analysis was performed on data derived from the National Centers for Health Statistics' Vital Statistics Data files (1995-2006). The primary outcomes examined were preterm birth, stillbirth, neonatal and infant mortality. During the study period, rates of labor induction among twins decreased by 8% and rates of cesarean delivery increased by 35%. Concurrently, the preterm birth rate increased by 13% from 54% in 1995-96 to 61% in 2005-06. The overall stillbirth rate, and neonatal and infant death rates decreased during the same period by 21% (95% confidence interval (CI): 18-25%), 13% (95% CI: 9-16%) and 12% (95% CI: 8-15%), respectively. There were significant reductions in neonatal death rates related to respiratory distress syndrome (RDS; 48%, 95% CI: ...
Neonatal Outcomes in Twin Pregnancies Delivered Moderately Preterm, Late Preterm, and Term
American Journal of Perinatology, 2010
We compared neonatal outcomes in twin pregnancies following moderately preterm birth (MPTB), late preterm birth (LPTB) and term birth. A secondary analysis of a multi-center, randomized controlled trial of multiple gestations was conducted. MPTB was defined as delivery between 32 0/7 and 33 6/7 weeks and LPTB between 34 0/7 and 36 6/7 weeks. Primary outcome was a neonatal outcome composite consisting of one or more of the following: neonatal death, respiratory distress syndrome, early onset culture-proven sepsis, stage 2 or 3 necrotizing enterocolitis, bronchopulmonray dysplasia, grade 3 or 4 intraventricular hemorrhage, periventricular leukomalacia, pneumonia, or severe retinopathy of prematurity. Among 552 twin pregnancies, the MPTB rate was 14.5%, LPTB 49.8% and term birth rate 35.7%. The rate of the primary outcome was different between groups: 30.0% for MPTB, 12.8% for LPTB, 0.5% for term (p< 0.001). Compared with term neonates, the primary neonatal outcome composite was increased following MPTB (relative risk [RR] 58.5; 95% confidence interval [CI] 11.3 to 1693.0) and LPTB (RR 24.9; 95% CI 4.8 to 732.2). Twin pregnancies born moderately and late preterm encounter higher rates of neonatal morbidities compared to twins born at term.
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.
2020
Background: In the Twin Birth Study, women at 320/7-386/7 weeks of gestation, in whom the first twin was in cephalic presentation, were randomized to planned vaginal delivery or cesarean section. The study found no significant differences in neonatal or maternal outcomes in the two planned mode of delivery groups. We aimed to compare neonatal and maternal outcomes of twin gestations without spontaneous onset of labor, who underwent induction of labor or pre-labor cesarean section as the intervention of induction may affect outcomes.Methods: In this secondary analysis of the Twin Birth Study we compared those who had an induction of labor with those who had a pre-labor cesarean section. The primary outcome was a composite of fetal or neonatal death or serious neonatal morbidity. Secondary outcome was a composite of maternal morbidity and mortality. Trial Registration: NCT00187369Results: Of the 2,804 women included in the Twin Birth Study, a total of 1,347 (48%) women required a deli...