Influence of mode of delivery on neonatal mortality in the second twin, at and before term (original) (raw)
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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.
Neonatal mortality in second twin according to cause of death, gestational age, and mode of delivery
American Journal of Obstetrics and Gynecology, 2004
Objective: The purpose of this study was to assess the risk of neonatal death in the second twin. Study design: We carried out a retrospective cohort study of 128,219 live born second twins in the United States for the years 1995 through 1997. The study subjects were divided into 3 groups: second twins who were delivered by cesarean delivery after vaginal delivery of the first twin (group 1), both twins delivered vaginally (group 2), and both twins delivered by cesarean delivery (group 3). Results: The risk of asphyxia-related neonatal deaths was increased in groups 1 and 2; the increased risk in group 1 was stronger in term births than in preterm births. Conclusion: The risk of neonatal deaths, especially for term infants with asphyxia-related deaths, is increased for the second twins who are delivered by cesarean delivery after vaginal delivery of the first twins.
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 ...
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2005
To determine a possible relationship between neonatal and maternal outcomes in twin gestations and the planned mode of delivery. Study design: A single-centre retrospective cohort study in twins !32 weeks of gestational age was performed. Baseline characteristics, and neonatal and maternal outcomes were documented according to the planned mode of delivery: a planned caesarean section or a planned vaginal birth. Statistical analysis was performed using chi-square test. Fisher exact test was used in case correction was needed. Results: During the study period (1999)(2000)(2001)(2002), 164 twins !32 weeks were enrolled in the study. In 29 women (17.7%) an elective caesarean section was performed. The remaining 135 twins (82.3%) were allowed to start a vaginal delivery. An emergency or an urgent secondary caesarean section for both twins was performed in 26 women, and in 2 women for twin B only. One twin B baby died during planned vaginal delivery. No significant differences in perinatal mortality and serious neonatal morbidity were found between both groups (10.3% versus 9.6%). Neonatal outcomes in twins A were significantly better than in twins B (2.4% versus 7.3%), independent of the planned mode of delivery. Serious maternal morbidity was not significantly different between both groups (13.8% versus 19.3%), although 2 women in the elective caesarean section group needed a relaparotomy for haemorrhage. Conclusion: Our results do not support an elective caesarean section for twin gestations !32 weeks. The success rate of vaginal delivery in the planned vaginal birth group was nearly 80%. #
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.
Journal of Perinatology, 2005
Objective: To assess the risk of neonatal mortality and morbidity in vertex-vertex second twins according to mode of delivery and birth weight. Study design: Data from a historical cohort study based on a twin registry in the US (1995-1997) were used. Multivariate logistic regression was used to control for maternal age, race, marital status, cigarette smoking during pregnancy, parity, medical complications, gestational age, and other confounders. Results: A total of 86 041 vertex-vertex second twins were classified into two groups: second twins delivered by cesarean section after cesarean delivery of first twin (C-C) (43.0%), second twins whose co-twins delivered vaginally (V-X) (57.0%). In infants of birth weight X2500 g group, the risks of noncongenital anomaly-related death (adjusted odds ratio (aOR): 4.64, 95% confidence interval (95% CI): 1.90, 13.92), low Apgar score (aOR: 2.39, 95% CI: 1.43, 4.14), and ventilation use (aOR: 1.31, 95% CI: 1.18, 1.47) were higher in the V-X group compared with the CC group. No asphyxia-related neonatal deaths occurred in CC group, whereas the incidence of this death was 0.04% in the V-X group. Conclusion: The risks of neonatal mortality and morbidity are increased in vertex-vertex second twins with birth weight X2500 g whose co-twins delivered vaginally compared with second twins delivered by cesarean section after cesarean delivery of first twin.
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.
Journal of Obstetrics & Gynaecology, 2012
To assess neonatal and maternal morbidity in twins ≥ 32 weeks ' gestation, related to the changes in planned mode of delivery, a retrospective cohort study was performed, including 185 twin births delivered in the Atrium Medical Centre, Heerlen, during the years 2003 -2008. The results were compared with those of an earlier study from our department during the period 1999 -2002. Compared with the 1999 -2002 cohort, the elective caesarean section rate signifi cantly increased from 17.7% to 36.8%. The secondary caesarean rate signifi cantly decreased from 15.9% to 8.8%, but increased from 1.2% to 3.3% for only twin B. No signifi cant diff erences in serious neonatal morbidity rates for twins A and B were found between both study periods, neither in the elective caesarean group, nor in the planned vaginal birth group. Serious maternal morbidity was not signifi cantly increased in both groups compared with the 1999 -2002 cohort.