Mode of delivery and neonatal outcomes in extremely preterm Vertex/nonVertex twins.
Adult
Birth Injuries
/ etiology
Breech Presentation
/ therapy
Case-Control Studies
Cesarean Section
Delivery, Obstetric
/ methods
Diseases in Twins
/ etiology
Female
Humans
Infant, Extremely Premature
Infant, Newborn
Infant, Premature, Diseases
/ etiology
Male
Pregnancy
Pregnancy, Twin
Premature Birth
/ therapy
Retrospective Studies
Treatment Outcome
Trial of Labor
adverse outcome
mode of delivery
nonVertex
twins
Journal
American journal of obstetrics and gynecology
ISSN: 1097-6868
Titre abrégé: Am J Obstet Gynecol
Pays: United States
ID NLM: 0370476
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
received:
07
06
2020
revised:
11
11
2020
accepted:
03
12
2020
pubmed:
12
12
2020
medline:
27
7
2021
entrez:
11
12
2020
Statut:
ppublish
Résumé
One of the controversies in the management of twin gestations relates to mode of delivery, especially when the second twin is in a nonvertex presentation (Vertex/nonVertex pairs) and birth is imminent at extremely low gestation. We hypothesized that, for Vertex/nonVertex twins born before 28 weeks' gestation, cesarean delivery would be associated with a lower risk of adverse neonatal outcomes than trial of vaginal delivery. Our aim was to test this hypothesis by comparing the neonatal outcomes of Vertex/nonVertex twins born before 28 weeks' gestation by mode of delivery using a large national cohort. This work is a retrospective cohort study of all twin infants born at 24 A total of 1082 twin infants (541 twin pairs) met the inclusion criteria: 220 Vertex/nonVertex pairs, of which 112 had a trial of vaginal delivery (study group) and 108 had cesarean delivery for both twins (control group 1); 170 pairs with the first twin in nonvertex presentation, all of which were born by cesarean delivery (control group 2); and 151 pairs with both twins in vertex presentation (vertex or nonvertex). In the study group, the rate of urgent cesarean delivery for the second twin was 30%. The rate of the primary outcome in the study group was 42%, which was not significantly different compared with control group 1 (37%; adjusted relative risk, 0.93; 95% confidence interval, 0.71-1.22) or control group 2 (34%; adjusted relative risk, 1.20; 95% confidence interval, 0.92-1.58). The findings remained similar when outcomes were analyzed separately for the first and second twins. For preterm Vertex/nonVertex twins born at <28 weeks' gestation, we found no difference in the risk of adverse neonatal outcome between a trial of vaginal delivery and primary cesarean delivery. However, a trial of vaginal delivery was associated with a high rate of urgent cesarean delivery for the second twin.
Sections du résumé
BACKGROUND
One of the controversies in the management of twin gestations relates to mode of delivery, especially when the second twin is in a nonvertex presentation (Vertex/nonVertex pairs) and birth is imminent at extremely low gestation.
OBJECTIVE
We hypothesized that, for Vertex/nonVertex twins born before 28 weeks' gestation, cesarean delivery would be associated with a lower risk of adverse neonatal outcomes than trial of vaginal delivery. Our aim was to test this hypothesis by comparing the neonatal outcomes of Vertex/nonVertex twins born before 28 weeks' gestation by mode of delivery using a large national cohort.
STUDY DESIGN
This work is a retrospective cohort study of all twin infants born at 24
RESULTS
A total of 1082 twin infants (541 twin pairs) met the inclusion criteria: 220 Vertex/nonVertex pairs, of which 112 had a trial of vaginal delivery (study group) and 108 had cesarean delivery for both twins (control group 1); 170 pairs with the first twin in nonvertex presentation, all of which were born by cesarean delivery (control group 2); and 151 pairs with both twins in vertex presentation (vertex or nonvertex). In the study group, the rate of urgent cesarean delivery for the second twin was 30%. The rate of the primary outcome in the study group was 42%, which was not significantly different compared with control group 1 (37%; adjusted relative risk, 0.93; 95% confidence interval, 0.71-1.22) or control group 2 (34%; adjusted relative risk, 1.20; 95% confidence interval, 0.92-1.58). The findings remained similar when outcomes were analyzed separately for the first and second twins.
CONCLUSION
For preterm Vertex/nonVertex twins born at <28 weeks' gestation, we found no difference in the risk of adverse neonatal outcome between a trial of vaginal delivery and primary cesarean delivery. However, a trial of vaginal delivery was associated with a high rate of urgent cesarean delivery for the second twin.
Identifiants
pubmed: 33306970
pii: S0002-9378(20)31368-5
doi: 10.1016/j.ajog.2020.12.002
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
613.e1-613.e10Subventions
Organisme : CIHR
ID : CTP 87518
Pays : Canada
Investigateurs
Prakesh S Shah
(PS)
Joseph Ting
(J)
Zenon Cieslak
(Z)
Rebecca Sherlock
(R)
Ayman Abou Mehrem
(A)
Jennifer Toye
(J)
Carlos Fajardo
(C)
Zarin Kalapesi
(Z)
Jaya Bodani
(J)
Koravangattu Sankaran
(K)
Sibasis Daspal
(S)
Mary Seshia
(M)
Deepak Louis
(D)
Ruben Alvaro
(R)
Amit Mukerji
(A)
Orlando Da Silva
(O)
Mohammad Adie
(M)
Kyong-Soon Lee
(KS)
Michael Dunn
(M)
Brigitte Lemyre
(B)
Faiza Khurshid
(F)
Ermelinda Pelausa
(E)
Keith Barrington
(K)
Anie Lapoint
(A)
Guillaume Ethier
(G)
Christine Drolet
(C)
Bruno Piedboeuf
(B)
Martine Claveau
(M)
Marc Beltempo
(M)
Valerie Bertelle
(V)
Edith Masse
(E)
Roderick Canning
(R)
Hala Makary
(H)
Cecil Ojah
(C)
Luis Monterrosa
(L)
Julie Emberley
(J)
Jehier Afifi
(J)
Andrzej Kajetanowicz
(A)
Shoo K Lee
(SK)
Haim Abenhaim
(H)
Jehier Afifi
(J)
Ruben Alvaro
(R)
James Andrews
(J)
Anthony Armson
(A)
Francois Audibert
(F)
Khalid Aziz
(K)
Marilyn Ballantyne
(M)
Jon Barrett
(J)
Marc Beltempo
(M)
Anick Berard
(A)
Valerie Bertelle
(V)
Lucie Blais
(L)
Alan Bocking
(A)
Jaya Bodani
(J)
Jason Burrows
(J)
Kimberly Butt
(K)
Roderick Canning
(R)
George Carson
(G)
Nils Chaillet
(N)
Sue Chandra
(S)
Paige Church
(P)
Zenon Cieslak
(Z)
Kevin Coughlin
(K)
Joan Crane
(J)
Dianne Creighton
(D)
Orlando Da Silva
(O)
Thierry Daboval
(T)
Leanne Dahlgren
(L)
Sibasis Daspal
(S)
Cecilia de Cabo
(C)
Akhil Deshpandey
(A)
Kimberly Dow
(K)
Christine Drolet
(C)
Michael Dunn
(M)
Salhab El Helou
(S)
Darine El-Chaar
(D)
Walid El-Naggar
(W)
Carlos Fajardo
(C)
Jonathan Foster
(J)
Robert Gagnon
(R)
Rob Gratton
(R)
Victor Han
(V)
Adele Harrison
(A)
Shabih Hasan
(S)
Michael Helewa
(M)
Matthew Hicks
(M)
K S Joseph
(KS)
Andrzej Kajetanowicz
(A)
Zarin Kalapesi
(Z)
Thierry Lacaze-Masmonteil
(T)
Kyong-Soon Lee
(KS)
Brigitte Lemyre
(B)
Abhay Lodha
(A)
Deepak Louis
(D)
Thuy Mai Luu
(TM)
Linh Ly
(L)
Annette Majnemer
(A)
Hala Makary
(H)
Isabelle Marc
(I)
Edith Masse
(E)
Sarah D McDonald
(SD)
Doug McMillan
(D)
Nir Melamed
(N)
Amy Metcalfe
(A)
Diane Moddemann
(D)
Luis Monterrosa
(L)
Michelle Morais
(M)
Amit Mukerji
(A)
William Mundle
(W)
Lynn Murphy
(L)
Kellie Murphy
(K)
Anne-Monique Nuyt
(AM)
Chuks Nwaesei
(C)
Karel O'Brien
(K)
Martin Offringa
(M)
Cecil Ojah
(C)
Annie Ouellet
(A)
Jean-Charles Pasquier
(JC)
Petros Pechlivanoglou
(P)
Ermelinda Pelausa
(E)
Bruno Piedboeuf
(B)
Elodie Portales-Casamar
(E)
Shahirose Premji
(S)
Pramod Puligandla
(P)
Eleanor Pullenayegum
(E)
Amber Reichert
(A)
Kate Robson
(K)
Carol Schneider
(C)
Mary Seshia
(M)
Prakesh S Shah
(PS)
Vibhuti Shah
(V)
Rebecca Sherlock
(R)
Sandesh Shivananda
(S)
Nalini Singhal
(N)
Erik Skarsgard
(E)
Amanda Skoll
(A)
Graeme Smith
(G)
Anne Synnes
(A)
Katherine Thériault
(K)
Joseph Ting
(J)
Suzanne Tough
(S)
Jennifer Toye
(J)
Jagdeep Ubhi
(J)
Michael Vincer
(M)
Wendy Whittle
(W)
Hilary Whyte
(H)
Doug Wilson
(D)
Stephen Wood
(S)
Philip Ye
(P)
Wendy Yee
(W)
Jill Zwicker
(J)
Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.