Twin Birth Study: 2-year neurodevelopmental follow-up of the randomized trial of planned cesarean or planned vaginal delivery for twin pregnancy - 28/02/16

Doi : 10.1016/j.ajog.2015.12.051

Elizabeth V. Asztalos, MD ^a,^⁎ , Mary E. Hannah, MD, CM ^d, Eileen K. Hutton, PhD ^g, Andrew R. Willan, PhD ^e, Alexander C. Allen, MD, CM ⁱ, B. Anthony Armson, MD ^j, Amiram Gafni, DSc ^h, K.S. Joseph, MD, PhD ^k, Arne Ohlsson, MD ^f, Susan Ross, PhD ^l, J. Johanna Sanchez, MIPH ^c, Kathryn Mangoff, BSc ^c, Jon F.R. Barrett, MB BCh, MD ^b
^a Department of Newborn and Developmental Pediatrics, Sunnybrook Health Sciences Center, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
^b Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
^c Center for Mother, Infant, and Child Research, Sunnybrook Health Sciences Center, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
^d Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
^e Department of Ontario Child Health Support Unit, SickKids Research Institute, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
^f Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
^g Midwifery Education Program, McMaster University, Hamilton, Ontario, Canada
^h Center for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
ⁱ Department of Pediatrics, Izaak Walton Killam Health Center, Dalhousie University, Halifax, Nova Scotia, Canada
^j Department of Obstetrics and Gynecology, Izaak Walton Killam Health Center, Dalhousie University, Halifax, Nova Scotia, Canada
^k Department of Obstetrics and Gynecology and the School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
^l Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada

^∗Corresponding author: Elizabeth V. Asztalos, MD.

Abstract

Background

The Twin Birth Study randomized women with uncomplicated pregnancies, between 32^0/7-38^6/7 weeks’ gestation where the first twin was in cephalic presentation, to a policy of either a planned cesarean or planned vaginal delivery. The primary analysis showed that planned cesarean delivery did not increase or decrease the risk of fetal/neonatal death or serious neonatal morbidity as compared with planned vaginal delivery.

Objective

This study presents the secondary outcome of death or neurodevelopmental delay at 2 years of age.

Study Design

A total of 4603 children from the initial cohort of 5565 fetuses/infants (83%) contributed to the outcome of death or neurodevelopmental delay. Surviving children were screened using the Ages and Stages Questionnaire with abnormal scores validated by a clinical neurodevelopmental assessment. The effect of planned cesarean vs planned vaginal delivery on death or neurodevelopmental delay was quantified using a logistic model to control for stratification variables and using generalized estimating equations to account for the nonindependence of twin births.

Results

Baseline maternal, pregnancy, and infant characteristics were similar. Mean age at assessment was 26 months. There was no significant difference in the outcome of death or neurodevelopmental delay: 5.99% in the planned cesarean vs 5.83% in the planned vaginal delivery group (odds ratio, 1.04; 95% confidence interval, 0.77–1.41; P = .79).

Conclusion

A policy of planned cesarean delivery provides no benefit to children at 2 years of age compared with a policy of planned vaginal delivery in uncomplicated twin pregnancies between 32^0/7-38^6/7weeks’ gestation where the first twin is in cephalic presentation.

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Key words : cesarean vs vaginal delivery, neurodevelopmental outcome, twin pregnancies

Plan

Introduction

Materials and Methods

Initial study

Two-year neurodevelopmental follow-up

Study oversight

Statistical analysis

Results

Characteristics of the participants

Death or neurodevelopmental delay

Subgroup analyses

Comment

Conclusion

	The Twin Birth Study Collaborative Group is listed at the end of the article.
	This study was supported by a grant (63164) from the Canadian Institutes of Health Research.
	The authors report no conflict of interest.
	Cite this article as: Asztalos EV, Hannah ME, Hutton EK, et al. Twin Birth Study: 2-year neurodevelopmental follow-up of the randomized trial of planned cesarean or planned vaginal delivery for twin pregnancy. Am J Obstet Gynecol 2016;214:371.e1-19.

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Vol 214 - N° 3

P. 371.e1-371.e19 - mars 2016 Retour au numéro

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Twin Birth Study: 2-year neurodevelopmental follow-up of the randomized trial of planned cesarean or planned vaginal delivery for twin pregnancy - 28/02/16

Abstract

Background

Objective

Study Design

Results

Conclusion

Plan

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