Delivery of monochorionic twins: lessons learned from the Twin Birth Study - 24/11/20
, Hayley Lipworth, BSc, BEd a, Elizabeth V. Asztalos, MD b, Elad Mei-Dan, MD a, c, Nir Melamed, MD a, Xingshan Cao, PhD d, Arthur Zaltz, MD a, Lone Hvidman, MD e, Jon F.R. Barrett, MD aAbstract |
Background |
The current literature regarding the recommended mode of delivery of monochorionic-diamniotic twins is limited to small numbers, retrospective studies, and comparisons of outcomes of monochorionic-diamniotic twin pregnancies with those of dichorionic-diamniotic twin pregnancies instead of outcomes of trial of labor vs elective cesarean delivery of monochorionic-diamniotic twins.
Objective |
This study aimed to compare perinatal and maternal outcomes of planned cesarean delivery and planned vaginal delivery of monochorionic-diamniotic twins using the Twin Birth Study data.
Study Design |
This study is a secondary analysis of the Twin Birth Study. Women were randomized from 32 weeks and 0 days gestation to 38 weeks and 6 days gestation to planned cesarean delivery or planned vaginal delivery. Twin A in the cephalic presentation and estimated weight of each twin between 1500 and 4000 grams were the inclusion criteria. Pregnancies complicated by fetal reduction after 13 weeks of gestation, lethal fetal anomaly, or contraindication to vaginal delivery were excluded. Elective delivery was planned between 37 weeks and 5 to 7 days of gestation and 38 weeks and 6 to 7 days of gestation. Perinatal and maternal outcomes of monochorionic-diamniotic twin pregnancies were compared between those randomized for planned cesarean delivery and those randomized for planned vaginal delivery. In addition, outcomes of monochorionic-diamniotic twin pregnancies were compared with those of dichorionic-diamniotic twin pregnancies.
Results |
Out of the 1393 women in each arm, 346 (24.9%) women in the planned cesarean delivery arm and 324 (23.3%) women in the planned vaginal delivery arm had monochorionic-diamniotic twin pregnancies and were eligible for the first analysis. The rate of cesarean delivery was 39.2% in the planned vaginal delivery arm and was 91.3% in the planned cesarean delivery arm. There was no significant difference in gestational age at delivery between the groups (34.4±1.8 weeks vs 34.5±1.8 weeks; P=.78). No difference was found in maternal outcomes. As for perinatal outcomes, the rate of the primary adverse neonatal composite outcomes in twins A or twins B was similar in both the planned vaginal delivery and the planned cesarean delivery arms (twins A, 1.2% vs 1.2% [P=.92]; twins B, 1.2% vs 3.2% [P=.09]). Within the planned cesarean delivery arm, the rate of primary adverse neonatal composite outcome was higher in twins B than twins A (3.2% vs 1.2%; P=.03). There was no difference in the primary adverse neonatal composite outcome between twins A in the monochorionic-diamniotic group and the dichorionic-diamniotic group (1.2% vs 1.3%; P=.89) or between twins B in similar groups (2.3% vs 2.7%; P=.47).
Conclusion |
In monochorionic-diamniotic twin pregnancy between 32 weeks and 0 to 7 days of gestation and 38 weeks and 6 to 7 days of gestation, with twin A in a cephalic presentation, planned cesarean delivery did not decrease or increase the risk of fetal or neonatal death or serious neonatal morbidity, as compared with planned vaginal delivery.
Le texte complet de cet article est disponible en PDF.Key words : cesarean delivery, maternal and perinatal outcomes, mode of delivery, monochorionic-diamniotic twins, vaginal delivery
Plan
| The authors report no conflict of interest. |
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| The Twin Birth Study was funded by the Canadian Institutes of Health Research (CIHR). The CIHR had no role in the design, management, data collection, analysis, or interpretation of the data. The CIHR had no role in the writing of this manuscript or in the decision to submit for publication. |
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| This study was registered on ClinicalTrials.gov with registration number NCT00187369 and current controlled trial number ISRCTN74420086. |
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| Cite this article as: Aviram A, Lipworth H, Asztalos EV, et al. Delivery of monochorionic twins: lessons learned from the Twin Birth Study. Am J Obstet Gynecol 2020;223:916.e1-9. |
Vol 223 - N° 6
P. 916.e1-916.e9 - décembre 2020 Retour au numéro
Article précédent
- Coronavirus disease 2019 in pregnancy was associated with maternal morbidity and preterm birth
- Loïc Sentilhes, Fanny De Marcillac, Charlotte Jouffrieau, Pierre Kuhn, Vincent Thuet, Yves Hansmann, Yvon Ruch, Samira Fafi-Kremer, Philippe Deruelle
- June 2020 (vol. 222, no. 6, page 624.e2)
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