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

Korb, Diane; Deneux‐Tharaux, Catherine; Goffinet, François; Schmitz, Thomas

doi:10.1038/s41598-020-61720-w

Cited by 11 publications

(10 citation statements)

References 21 publications

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“…Moreover, Madar et al [ 20 ] recently found that one fifth of the association between twin pregnancy and severe maternal outcomes may be mediated by caesarean delivery, yet caesarean rate was also high for single births in our sample. Recent findings from a French study verified that caesarean for the second twin and for both twins had higher risk of severe maternal morbidity compared to vaginal delivery for both twins [ 39 ], which also emphasizes the importance of reducing caesarean rates for twins in Brazil.…”

Section: Discussionmentioning

confidence: 91%

Twin pregnancy and perinatal outcomes: Data from ‘Birth in Brazil Study’

et al. 2021

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Background Twin pregnancies account for 0.5–2.0% of all gestations worldwide. They have a negative impact on perinatal health indicators, mainly owing to the increased risk for preterm birth. However, population-based data from low/middle income countries are limited. The current paper aims to understand the health risks of twins, compared to singletons, amongst late preterms and early terms. Methods Data is from “Birth in Brazil”, a national inquiry into childbirth care conducted in 2011/2012 in 266 maternity hospitals. We included women with a live birth or a stillborn, and excluded births of triplets or more, totalling 23,746 singletons and 554 twins. We used multiple logistic regressions and adjusted for potential confounders. Results Twins accounted for 1.2% of gestations and 2.3% of newborns. They had higher prevalence of low birth weight and intrauterine growth restriction, when compared to singletons, in all gestational age groups, except in the very premature ones (<34 weeks). Amongst late preterm’s, twins had higher odds of jaundice (OR 2.7, 95% CI 1.8–4.2) and antibiotic use (OR 1.8, 95% CI 1.1–3.2). Amongst early-terms, twins had higher odds of oxygen therapy (OR 2.7, 95% CI 1.3–5.9), admission to neonatal intensive care unit (OR 3.1, 95% CI 1.5–6.5), transient tachypnoea (OR 3.7, 95% CI 1.5–9.2), jaundice (OR 2.8, 95% CI 1.3–5.9) and antibiotic use (OR 2.2, 95% CI 1.14.9). In relation to birth order, the second-born infant had an elevated likelihood of jaundice, antibiotic use and oxygen therapy, than the first-born infant. Conclusion Although strongly mediated by gestational age, an independent risk remains for twins for most neonatal morbidities, when compared to singletons. These disadvantages seem to be more prominent in early-term newborns than in the late preterm ones.

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Section: Discussionmentioning

confidence: 91%

Twin pregnancy and perinatal outcomes: Data from ‘Birth in Brazil Study’

et al. 2021

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“…are guided by a pragmatic view about cervical ripening, such as all large prospective observational studies in obstetrics [30][31][32][33]. These studies allow multiple analyses of data and conclusions about pragmatic management and consequences of some current obstetric conditions that were not adapted to randomized controlled trials (i.e., twins with The JUmeaux MODe d'Accouchement (JUMODA) study) [30,[34][35][36][37][38][39].…”

Section: Discussionmentioning

confidence: 99%

Prospective observational study investigating the effectiveness, safety, women’s experiences and quality of life at 3 months regarding cervical ripening methods for induction of labor at term—The MATUCOL study protocol

et al. 2022

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Background The purposes of successful induction of labor (IOL) are to shorten the time for IOL to delivery, increase the vaginal delivery rate, and reduce the rate of maternal and neonatal morbidity. In cases of unfavorable cervix (Bishop score <6), cervical ripening is advised to improve vaginal delivery rate. It may be initiated by mechanical (double balloon catheter (DBC), synthetic osmotic dilator) or pharmacologic (prostaglandins) methods, and the problem is complex due to the multitude of cervical ripening methods. We are constantly looking for the optimal protocol of cervical ripening for each woman. The present study aims to elucidate whether cervical ripening method is associated with increase rate of vaginal delivery, good women’s experience and unaltered long-term quality of life after cervical ripening at term regarding maternal and obstetric characteristics. Methods and design The MATUCOL study is a monocentric, prospective, observational study of all consecutive women who required cervical ripening (Bishop score <6) using different methods (DBC, vaginal dinoprostone, oral misoprostol) with a live fetus at term (≥37 weeks) between January 2020 and August 2021. The outcomes will be mode of delivery, maternal and neonatal morbidity, discomfort/pain assessments during cervical ripening, women’s experience and satisfaction, and the impact of cervical ripening on the health-related quality of life at 3 months. If it reports a significant efficacy/safety/perinatal morbidity/women’s satisfaction/quality of life at 3 months post-delivery associated with a method of cervical ripening in a specific situation (gestational and/or fetal disease) using a multivariate analysis, its use should be reconsidered in clinical practice. Discussion This study will reveal that some cervical ripening methods will be more effectiveness, safe, with good women’s experiences and QOL at 3 months compared to others regarding maternal and obstetric characteristics. Trial registration This study is being performed at La Roche sur Yon Hospital following registration as GNEDS on January 8, 2020.

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“…The greater risk for mothers undergoing an unplanned CS must be kept in mind when counselling women on the mode of birth with twin pregnancies. The literature reports higher risks of short-term complications in mothers undergoing unplanned secondary CS compared to planned primary CS and vaginal delivery mainly due to higher anaesthesia- and surgery-related morbidity [ 24 – 26 ]. The results of our research, however, confirm that vaginal birth for monochorionic twins ≥36 weeks of gestation is just as safe as for women with DC-DA pregnancies.…”

Section: Discussionmentioning

confidence: 99%

Mode of birth in monochorionic versus dichorionic twin pregnancies: a retrospective study from a large tertiary centre in Germany

Wandel

Abele

Pauluschke‐Fröhlich

et al. 2022

BMC Pregnancy Childbirth

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Background Optimal mode of birth for twins, in particular monochorionic twins, has been the subject of much debate. This retrospective study compared maternal and newborn outcomes after vaginal birth in monochorionic and dichorionic twins, utilizing a large institutional database. Methods Retrospective analysis focusing on 98 monochorionic-diamniotic (MC-DA) and 540 dichorionic-diamniotic (DC-DA) twin births extracted from the perinatal database of a large German hospital. Pregnancies ≥36 weeks of gestation with two viable foetuses born between 2004 and 2014 divided into planned vaginal and planned caesarean delivery were included. Descriptive analysis was performed for maternal characteristics. Odds ratios (OR) with 95% confidences intervals (CI) tested the predictive effect of vaginal birth on neonatal and maternal outcomes. Results 51.0% MC-DA and 46.7% DC-DA twin pregnancies were planned vaginal births and 44.0% MC-DA mothers and 43.7% DC-DA mothers actually gave birth vaginally. The overall rate of caesarean section (CS) during the years under observation was 79.6% for MC-DA and 77.0% for DC-DA pregnancies. There were no significant differences in neonatal outcome between the subsamples, although acidosis was observed more often in the second DC-DA twin and Apgar scores < 7 were observed more often in MC-DA twins. Conclusion Vaginal birth may be recommended as an option to women with monochorionic twins as no significant differences in outcomes were found between MC-DA and DC-DA twins. However, over half of planned vaginal twin births resulted in CS.

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

Cited by 11 publications

References 21 publications

Twin pregnancy and perinatal outcomes: Data from ‘Birth in Brazil Study’

Twin pregnancy and perinatal outcomes: Data from ‘Birth in Brazil Study’

Prospective observational study investigating the effectiveness, safety, women’s experiences and quality of life at 3 months regarding cervical ripening methods for induction of labor at term—The MATUCOL study protocol

Mode of birth in monochorionic versus dichorionic twin pregnancies: a retrospective study from a large tertiary centre in Germany

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