Planned Cesarean or planned vaginal delivery for twins: secondary analysis of randomized controlled trial

Abstract

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process which may lead to differences between this version and the Version of Record. Please cite this article as

Neonatal and Maternal Outcomes in Spontaneously-Conceived Twin Pregnancies According to Mode of Delivery

“…Appropriate intrapartum conduct in a twin delivery remains a challenging aspect of obstetric practice. 3,4,19 This cohort study found that composite neonatal and maternal outcomes were superior with VD. Prior to 2013, the tendency was to deliver twins by elective CS, mainly due to the high rate of malpresentation, featuring interlocked twins, as well as the risk of acute hypoxia in the second twin from decreased placental circulation and trauma to the premature fetal brain upon passage through the birth canal.…”

“…Zamarfand et al elaborate that the impact of gestational age on composite perinatal outcome at gestations < 33 weeks as prematurity-induced morbidity may mask the effect of delivery mode compared to a term delivery. 4 The authors also discuss the protective effect that VD exerts on twins delivered at earlier gestations than 33 weeks, resulting in a lower need for mechanical ventilation. 4 A strong statistical correlation was identified between CS and neonatal intensive care unit (NICU) admission: 53.2% vs. 1.5% (p=0.0001).…”

“…4 The authors also discuss the protective effect that VD exerts on twins delivered at earlier gestations than 33 weeks, resulting in a lower need for mechanical ventilation. 4 A strong statistical correlation was identified between CS and neonatal intensive care unit (NICU) admission: 53.2% vs. 1.5% (p=0.0001). Moreover, neonatal LOS in the NICU was significantly longer in the CS group; range: 1-68 days, average: 22.78 days compared to the VD group: 1-30, 12.05 days).…”

“…1 In contrast, spontaneous conception of twins is a rarity compared to IVF conception, however, there is evidence that high consumption of red meat and a maternal history of twin gestation are associated with spontaneous conception of twins. 2 Conduct in a twin delivery continues to be one of the most challenging aspects of obstetric practice 3,4 and the optimal mode of delivery remains elusive. 5 There is an abundance of literature demonstrating that women carrying a twin pregnancy experience higher rates of complications during pregnancy and delivery compared to their counterparts carrying a singleton pregnancy.…”

“…The main short-term complications include intra or postpartum haemorrhage and infection, while long-term complications of a scarred uterus comprise morbidly adherent placental disorders and uterine rupture. 4,[15][16][17] No randomised controlled trials were successful in identifying the optimal mode and timing of delivery in twin pregnancies until 2013. Since then, the Twin Birth Study (TBS) provided pivotal evidence that neonatal outcomes following VD were superior to CS when the leading twin was in vertex presentation, at a minimum 32 weeks gestation and an experienced obstetrician was present at delivery.…”