203: Notable outcomes in twin neonates by planned mode of delivery

Abstract

The Twin Birth Study (TBS) documented no differences in neonatal deaths and serious neonatal morbidity between planned vaginal delivery (VD) and planned cesarean section (CS) in twin pregnancies. Adverse outcomes that may not result in mortality or severe morbidity are nonetheless noteworthy in the discussion of mode of delivery in twin pregnancies. The objective of our study was to compare these adverse events between planned vaginal delivery and planned CS in twin pregnancy. This was a secondary analysis of the TBS. Women with a twin pregnancy at a gestational age of 34+0 to 38+6 weeks with the first twin in the vertex presentation were randomized to planned CS or planned VD. The primary outcome was a composite of respiratory and neurological morbidities and neonatal care unit admission (Table). Multivariable logistic regression analysis was used to identify factors associated with the composite adverse neonatal outcomes. A total of 1304 women (2588 fetuses) were randomly assigned to planned CS and 1326 women (2632 fetuses) to planned VD. The rate of cesarean section was 90.1% in the planned CS group and 40.3% in the planned VD group. Demographic and obstetrical characteristics were similar between the groups. There was no significant difference in the composite primary outcome between the planned CS group and the planned VD group (Table). Subsequently, sub-analysis by gestational age at delivery revealed that at 34-35 weeks’ gestation, the rate of the primary composite outcome was lower in neonates in the planned CS group49.4% and 56.1%, p=0.02). Stratification by actual mode of delivery found no difference in the composite outcome between the groups, although the respiratory morbidity was higher among those delivered by CS in comparison to those delivered by VD (9.7% and 7.6%, p=0.009). Factors that were independently associated with notable adverse outcome were birth at 34-37 weeks and being 2nd born twin in CS (Table). Our results strengthen the original TBS finding that showed that there are no benefits to planned CS, as compared with planned VD, in twins between 34+0 weeks and 38+6 weeks of gestation if the first twin is in the cephalic presentation. These findings are reassuring for a woman with twin pregnancy choosing planned VD as a mode of delivery.