Association Between Planned Cesarean Delivery and Neonatal Mortality and Morbidity in Twin Pregnancies

Schmitz, Thomas; Prunet, C.; Azria, Élie; Bohec, Caroline; Bongain, A.; Chabanier, P; D’ercole, C.; Deruelle, Philippe; Tayrac, Renaud de; Dreyfus, Michel; Dupont, Céline; Gondry, J.; Graesslin, Olivier; Kayem, Gilles; Langer, Bruno; Marpeau, L.; Morel, Olivier; Parant, Olivier; Perrotin, Franck; Pierre, Fabrice H.F.; Poulain, Patrice; Riethmuller, Didier; Rozenberg, Patrick; Rudigoz, R.-C.; Sagot, Paul; Sénat, Marie-Victoire; Sentilhes, Loïc; Vayssière, Christophe; Venditelli, F.; Verspyck, É.; Winer, Norbert; Lecomte-Raclet, Laurence; Ancel, Pierre‐Yves; Goffinet, François

doi:10.1097/aog.0000000000002048

Cited by 85 publications

(69 citation statements)

References 21 publications

(29 reference statements)

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“…However, the Twin Birth Study in 2013 reported that there were no significant benefits in planned CS for uncomplicated twins pregnancies 43 . The JUMODA study confirmed that planned CS (compared with planned vaginal delivery) for twins could be associated with increased composite neonatal mortality and morbidity, particularly when delivery was before 37 weeks 44 . Nevertheless, there is a strong preference among mothers with twin pregnancies for planned CS, which is likely to be compounded by the clinician's lack of confidence in conducting complex vaginal deliveries 45 .…”

Section: Category 8 (Multiple Pregnancies)mentioning

confidence: 84%

20-year trend in Caesarean section rates in primiparous women in a regional obstetric unit in Hong Kong

2019

Hong Kong J Gynaecol Obstet Midwifery

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Introduction: Using the Robson classification, we analysed the 20-year trend of Caesarean section (CS) rates among primiparous women in a regional obstetric unit in Hong Kong. Methods: Deliveries over a 20-year period (1997-2016) from United Christian Hospital were classified into one of 10 categories according to the Robson classification. The annual CS rate was calculated for each category, and data were stratified into four 5-year intervals to determine any trends. Results: A total of 86 908 deliveries from 1997 to 2016 were included for analysis. The overall CS rate increased from 17.5% to 23.5% over the period. However, the overall primiparous CS rate only increased modestly from 20.8% to 22.8%, with main contributors being breech presentation (category 6), multiple pregnancies (category 8), and preterm labour (category 10). Contrarily, the CS rate declined mildly among those with spontaneous and induced labour (category 1 and 2). These trends were significant (p<0.001) after stratification into four 5-year intervals. Conclusion: Despite a sharper rise in overall CS rate over the past 20 years, the CS rates in primiparous women increased modestly, mainly because of modest increases in rates of breech presentation, multiple pregnancies, and preterm labour.

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Section: Category 8 (Multiple Pregnancies)mentioning

confidence: 84%

20-year trend in Caesarean section rates in primiparous women in a regional obstetric unit in Hong Kong

2019

Hong Kong J Gynaecol Obstet Midwifery

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“…The national, observational, prospective, population-based cohort study of the mode of delivery of twin pregnancies (JUMODA: JUmeaux MODe d' Accouchement) conducted by Schmitz et al 4 , took place in France from 10 February, 2014, through 1 March, 2015. All French maternity units performing more than 1,500 annual deliveries were invited to participate, and 176 of the 191 eligible units (92%) agreed.…”

Section: Methodsmentioning

confidence: 99%

“…Detailed information about the participating women and maternity units has been reported by Schmitz et al 4 . Briefly, this cohort was specially designed to assess the effect of the mode of delivery on neonatal and maternal outcomes in twin pregnancies at or after 22 weeks of gestation (N = 8,823 women included).…”

Section: Methodsmentioning

confidence: 99%

“…Twin pregnancies are increasingly frequent in developed countries and concern about 3% of all births in the United States and France 1,2 . Results of informative studies since 2013 have shown the absence of neonatal or maternal benefits associated with planned cesarean and thus encourage professionals and women to plan vaginal delivery [3][4][5] . Nonetheless, data are sparse about severe acute maternal morbidity according to the actual mode of delivery after vaginal delivery is planned for twin pregnancies.…”

mentioning

confidence: 99%

“…Cesareans for the second twin, performed at full dilation and after the first twin has passed through the birth canal, possibly after intrauterine manoeuvres, are consequently at potentially high risk of maternal morbidity, including infection and postpartum hemorrhage. The reported rates of cesareans for the second twin range from 0.5% to more than 10% [5][6][7][8][9][10] and for both twins from 19.6% to 43.8% 3,4 . These large rate ranges may reflect wide variations in practices related to heterogeneous indications for cesareans and suggest that some of these procedures are performed when vaginal delivery might have been possible.…”

mentioning

confidence: 99%

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Severe maternal morbidity by mode of delivery in women with twin pregnancy and planned vaginal delivery

Korb

Deneux‐Tharaux

Goffinet

et al. 2020

Sci Rep

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Planned vaginal delivery in twin pregnancies has three potential outcomes: vaginal or cesarean delivery of both twins, or cesarean for the second twin. Our objective was to assess the association between delivery mode and severe acute maternal morbidity (SAMM) in women with twin pregnancies and planned vaginal deliveries. We limited this planned secondary analysis of the JUMODA cohort, a national prospective population-based study of twin deliveries, to women with planned vaginal delivery at or after 24 weeks of gestation who gave birth to two live fetuses at hospital. The association between delivery mode and SAMM was estimated from multivariate Poisson regression models. Of 5,055 women with planned vaginal delivery, 4,007 (79.3%) delivered both twins vaginally, 134 (2.6%) had cesarean for the second twin and 914 (18.1%) cesarean for both twins. Compared to vaginal delivery of both twins, the risk of SAMM was significantly higher after cesarean for the second twin (9.0% versus 4.5%; aRR 2.22, 95% CI 1.27-3.88) and for both twins (9.4% versus 4.5%, aRR 1.56, 95% CI 1.16-2.10). In twin pregnancies with planned vaginal delivery, cesarean deliveries for the second twin and for both twins are associated with higher risks of SAMM than vaginal delivery.

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Mode of delivery of Finnish dichorionic and monochorionic‐diamniotic twins: A retrospective observational study including a risk score for intrapartum cesarean birth

Rissanen

Loukovaara

Gissler

et al. 2023

Health Science Reports

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Background and Aims Trial of labor is considered safe also among twins, yet nearly 50% are born via cesarean section in Finland. While planned cesarean births have declined among twins, intrapartum cesarean deliveries have risen, postulating evaluation of criteria for trial of labor. The objective of this study was to create an outline of the mode of delivery of dichorionic and monochorionic‐diamniotic Finnish twins. By evaluating risk factors for intrapartum cesarean delivery (CD), we aimed at creating a risk score for intrapartum cesarean birth for twins. Methods A retrospective observational study based on a cohort of dichorionic and monochorionic‐diamniotic twin pregnancies considered as candidates for trial of labor in 2006, 2010, 2014, and 2018 ( n = 720) was performed. Differences between parturients with vaginal delivery and intrapartum CD to identify potential risk factors for intrapartum CD were assessed. Logistic regression analysis ( n = 707) was used to further define risk score points for recognized risk factors. Results A total of 23.8% (171/720, 95% confidence interval [CI] = 20.7–26.9) of parturients experienced intrapartum CD. Induction of labor, primiparity, fear of childbirth, artificial reproductive technology, higher maternal age, and other than cephalic/cephalic presentation independently associated with intrapartum CD. The achieved total risk score ranged from 0 to 13 points with significantly higher points among the CD group (6.61 vs. 4.42, p < 0.001). Using ≥8 points as a cut‐off, 51.4% (56/109) were delivered by intrapartum CD (sensitivity = 33.73%, specificity = 90.20%, positive predictive value = 51.38%, negative predictive value = 81.61%). The total risk score had a fair predictive capability for intrapartum CD (area under the curve = 0.729, 95% CI = 0.685–0.773). Conclusion Fair‐level risk stratification could be achieved with higher maternal age, primiparity, induction of labor, artificial reproductive technology, fear of childbirth, and other than cephalic/cephalic presentation increasing the risk. Parturients with low‐risk score (0–7 points) appear to be the best candidates for trial of labor with acceptable CD rates in this group (18.4%).

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Association Between Planned Cesarean Delivery and Neonatal Mortality and Morbidity in Twin Pregnancies

Cited by 85 publications

References 21 publications

20-year trend in Caesarean section rates in primiparous women in a regional obstetric unit in Hong Kong

20-year trend in Caesarean section rates in primiparous women in a regional obstetric unit in Hong Kong

Severe maternal morbidity by mode of delivery in women with twin pregnancy and planned vaginal delivery

Mode of delivery of Finnish dichorionic and monochorionic‐diamniotic twins: A retrospective observational study including a risk score for intrapartum cesarean birth

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