Neonatal outcome of very preterm twins: policy of planned vaginal or cesarean delivery - 26/03/15

Doi : 10.1016/j.ajog.2015.02.020

Loïc Sentilhes, MD, PhD ^a,^⁎ , Anne Oppenheimer, MD ^b, Anne-Charlotte Bouhours, MD ^a, Estelle Normand ^b, Bassam Haddad, MD ^c, Philippe Descamps, MD ^a, Loïc Marpeau, MD ^d, François Goffinet, MD, PhD ^e, Gilles Kayem, MD, PhD ^b
^a Department of Obstetrics and Gynecology, Angers University Hospital, Angers, France
^b Department of Obstetrics and Gynecology, Départment Hospitalo Universitaire “Risks and Pregnancy” Louis Mourier Hospital, Assistance Publique-Hôpitaux de Paris, University Paris-Diderot, Colombes, France
^c Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal de Créteil, Assistance Publique-Hôpitaux de Paris, Créteil, France
^d Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France
^e Department of Obstetrics and Gynecology, Maternity Port-Royal Hospital, Cochin Assistance Publique-Hôpitaux de Paris, University René Descartes, Paris, France

^∗Corresponding author: Loïc Sentilhes, MD, PhD.

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Abstract

Objective

The objective of the study was to compare neonatal mortality and morbidity in very preterm twins with the first twin in cephalic presentation in hospitals with a policy of planned vaginal delivery (PVD) and those with a policy of planned cesarean delivery (PCD).

Study Design

Women with preterm cephalic first twins delivered after preterm labor and/or premature preterm rupture of membranes from 26^0/7 to 31^6/7 weeks of gestation were identified from the databases of 6 perinatal centers and classified as PVD or PCD according to the center’s management policy from 1999 to 2010. Severe neonatal morbidity was defined as any of the following: intraventricular hemorrhage grades 3-4, periventricular leukomalacia, necrotizing enterocolitis, bronchopulmonary dysplasia, and hospital death. The independent effect of the planned mode of delivery, defined by the center’s management policy, was tested and quantified with a 2-level multivariable logistic regression.

Results

The PVD group included 248 women, and the PCD group 63. Maternal characteristics did not differ between the 2 groups. The rate of vaginal delivery was 85.9% (213 of 248) vs 20.6% (13 of 63) (P < .001), and the rate of cesarean delivery for the second twin was 1.6% (4 of 248) vs 4.8% (3 of 63) (P = .13) for PVD and PCD. PVD had no independent effect on either newborn hospital mortality or severe neonatal composite morbidity.

Conclusion

A policy of planned vaginal delivery of very preterm twins with the first twin in cephalic presentation does not increase either severe neonatal morbidity or mortality.

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Key words : cesarean delivery, neonatal death, neonatal morbidity, preterm birth, twins

Plan

Materials and Methods

Results

Comment

Clinical implications

	The authors report no conflict of interest.
	Cite this article as: Sentilhes L, Oppenheimer A, Bouhours A-C, et al. Neonatal outcome of very preterm twins: policy of planned vaginal or cesarean delivery. Am J Obstet Gynecol 2015;212:xx-xx.