TY - JOUR
T1 - Neonatal outcomes according to actual delivery mode after planned vaginal delivery in women with a twin pregnancy
AU - Goossens, S.M.T.A.
AU - Ensing, S.
AU - Roumen, F.J.M.E.
AU - Nijhuis, J.G.
AU - Mol, B.
N1 - Funding Information:
We acknowledge Dr. Mark AHBM van der Hoeven † (MD, PhD, Neonatologist Maastricht University Medical Centre +, Department of Neonatology, Maastricht, The Netherlands) for his input in the earlier versions of this manuscript. BWM is supported by a NHMRC Investigator grant (GNT1176437).
Funding Information:
BWM is supported by a NHMRC Investigatorgrant ( GNT1176437 ), BWM reports consultancy for ObsEva, Merck Merck KGaA, iGenomix and Guerbet
Publisher Copyright:
© 2020
PY - 2021/1/1
Y1 - 2021/1/1
N2 - Objective: To compare, in women with twin pregnancy with the first twin in cephalic position, neonatal morbidity and mortality rates after actual 1) Vaginal delivery (VD) both twins versus 2) unplanned Cesarean Delivery (CD) of both twins and 3) after VD of twin A and CD of twin B (combined delivery).Study Design: We describe a nationwide cohort study of women pregnant with twins who planned to deliver vaginally between 32(+0) - 41(+6 )weeks with the first twin in cephalic position, between 2000-2012 in the Netherlands.We used multivariate logistic regression analysis to compare neonatal morbidity and mortality according to actual mode of delivery, overall, and for preterm and term groups separately.Results: We included 19,723 women of whom 15,785 women (80.0 %) delivered both twins by VD, 2926 (14.6 %) delivered both twins by unplanned CD, and 1012 (5.1 %) women delivered by combined delivery. After unplanned CD of both twins compared to VD more perinatal mortality (1 or more twins affected) was seen (adjusted Odds Ratio (aOR) 2.23 (95 % CI 1.26-4.129)), as was 'Asphyxia related morbidity' (aOR 2.44 (95 % CI 1.80-3.31), 'other morbidity' (aOR 1.34 (95 %Cl 1.17-1.54), and 'any morbidity or mortality' (a0R1.39 (95 % CI 1.22-1.58)). Less Trauma- related morbidity' after unplanned CD vs. VD (aOR 0.11 (95 % 0.02-0.79)) was seen.After combined delivery vs. VD, more perinatal mortality (aOR 7.75 (95 % CI 4.51-13.34)), more Asphyxia-related morbidity (aOR 6.67 (95 % C14.91-9.06), 'prematurity related morbidity' (aOR 2.11 (95 % CI 1.59-2.79) 'other morbidity' (aOR 2.01 (95 % CI 1.65-2.46), and 'any morbidity or mortality' (aOR 2.44 (95 % CI 2.04-2.91)) were noted. All outcomes expect 'trauma-associated morbidity' were more increased for twin B as compared to twin A.Conclusion: After unplanned CD of both twins vs. VD of both twins, a twofold increase in neonatal mortality is noted. Combined delivery vs. VD of both twins is associated with a sevenfold increase in perinatal mortality and a five-fold increase in asphyxia-related outcomes. Twin A is more affected after unplanned CD of both twins, while twin B is more affected after combined delivery. (C) 2020 Elsevier B.V. All rights reserved.
AB - Objective: To compare, in women with twin pregnancy with the first twin in cephalic position, neonatal morbidity and mortality rates after actual 1) Vaginal delivery (VD) both twins versus 2) unplanned Cesarean Delivery (CD) of both twins and 3) after VD of twin A and CD of twin B (combined delivery).Study Design: We describe a nationwide cohort study of women pregnant with twins who planned to deliver vaginally between 32(+0) - 41(+6 )weeks with the first twin in cephalic position, between 2000-2012 in the Netherlands.We used multivariate logistic regression analysis to compare neonatal morbidity and mortality according to actual mode of delivery, overall, and for preterm and term groups separately.Results: We included 19,723 women of whom 15,785 women (80.0 %) delivered both twins by VD, 2926 (14.6 %) delivered both twins by unplanned CD, and 1012 (5.1 %) women delivered by combined delivery. After unplanned CD of both twins compared to VD more perinatal mortality (1 or more twins affected) was seen (adjusted Odds Ratio (aOR) 2.23 (95 % CI 1.26-4.129)), as was 'Asphyxia related morbidity' (aOR 2.44 (95 % CI 1.80-3.31), 'other morbidity' (aOR 1.34 (95 %Cl 1.17-1.54), and 'any morbidity or mortality' (a0R1.39 (95 % CI 1.22-1.58)). Less Trauma- related morbidity' after unplanned CD vs. VD (aOR 0.11 (95 % 0.02-0.79)) was seen.After combined delivery vs. VD, more perinatal mortality (aOR 7.75 (95 % CI 4.51-13.34)), more Asphyxia-related morbidity (aOR 6.67 (95 % C14.91-9.06), 'prematurity related morbidity' (aOR 2.11 (95 % CI 1.59-2.79) 'other morbidity' (aOR 2.01 (95 % CI 1.65-2.46), and 'any morbidity or mortality' (aOR 2.44 (95 % CI 2.04-2.91)) were noted. All outcomes expect 'trauma-associated morbidity' were more increased for twin B as compared to twin A.Conclusion: After unplanned CD of both twins vs. VD of both twins, a twofold increase in neonatal mortality is noted. Combined delivery vs. VD of both twins is associated with a sevenfold increase in perinatal mortality and a five-fold increase in asphyxia-related outcomes. Twin A is more affected after unplanned CD of both twins, while twin B is more affected after combined delivery. (C) 2020 Elsevier B.V. All rights reserved.
KW - caesarean delivery
KW - cesarean delivery
KW - delivery method
KW - trial
KW - twin pregnancy
KW - TRIAL
KW - Caesarean delivery
KW - Delivery method
KW - CESAREAN DELIVERY
KW - Twin pregnancy
U2 - 10.1016/j.ejogrb.2020.10.047
DO - 10.1016/j.ejogrb.2020.10.047
M3 - Article
C2 - 33161210
SN - 0301-2115
VL - 256
SP - 17
EP - 24
JO - European Journal of Obstetrics & Gynecology and Reproductive Biology
JF - European Journal of Obstetrics & Gynecology and Reproductive Biology
ER -