328: Comparison of neonatal outcome in cases of planned vaginal delivery versus planned cesarean delivery from 260/7 to 316/7 weeks gestation for cephalic first twins

Abstract

328 Comparison of neonatal outcome in cases of planned aginal delivery versus planned cesarean delivery from 260/7 o 316/7 weeks gestation for cephalic first twins Loic Sentilhes, Anne Oppenheimer, Anne-Charlotte Bouhours, Estelle Normand, Bassam Haddad, Philippe Descamps, Loic arpeau, Francois Goffinet, Gilles Kayem Angers University Hospital, Obstetrics and Gynecology, Angers, France, Creteil University Hospital, Obstetrics and Gynecology, Creteil, France, Poissy University Hospital, Obstetrics and Gynecology, Poissy, France, Rouen University Hospital, Obstetrics and Gynecology, Rouen, France, Maternity of Port-Royal, Obstetrics and Gynecology, Paris, France, Louisourier University Hospital, Obstetrics and Gynecology, Louis-Mourier, rance OBJECTIVE: To compare neonatal outcome in preterm twins from 60/7 to 316/7 weeks gestation (WG) in centers with either a policy of lanned vaginal delivery (PVD) or planned cesarean delivery (PCD). STUDY DESIGN: Women with preterm cephalic first twins delivered fter preterm labor and/or Premature Preterm Rupture Of Memranes (PPROM) were identified from the databases of six perinatal enters and classified as PVD or PCD according to the center’s mangement policy from 1999 to 2009. Women were excluded in cases of oncephalic first twin, monoamniotic pregnancy, induced preterm elivery including preeclampsia, abruptio placentae, twin-to-twin ransfusion syndrome, intra uterine growth restriction, fetal deaths or n cases of diagnosed antenatal malformations. Severe neonatal comosite morbidity was defined as any of the following: intraventricular emorrhage grade 3 and 4, periventricular leukomalacia (PVL), nerotizing enterocolitis, bronchopulmonary dysplasia, and hospital eath. The independent association between planned mode of delivry and the risk of neonatal mortality or morbidity was tested and uantified with ORs through two-level multivariable logistic regresion modeling. RESULTS: 48 women were included in the PVD group and 63 in the CD. Maternal characteristics did not differ between the two groups. he rates of vaginal delivery and cesarean delivery for the second twin ere respectively 213 (86%) versus 13 (21%) (p 0.001) and 4 (2%) ersus 3 (5%) (p 0.13) for PVD and PCD. After adjustment for gesational age at delivery, PPROM and newborn sex, the risk of neonatal epsis and PVL was lower respectively for both twin and only second win in the PVD group. There were no differences in severe neonatal omposite morbidity or neonatal mortality for both twins. CONCLUSION: A planned vaginal delivery in cases of cephalic first twins from 260/7 to 316/7 weeks gestation do not increase neonatal morbidity and mortality for both first and second twin.