799: Neurodevelopmental outcome during the first year in twin neonates according to the mode of delivery

Abstract

The preferred mode of delivery in twin pregnancy is controversial, and most studies compared the short-term neonatal outcomes between planned vaginal delivery (PVD) and planned cesarean section (PCS). We conducted this study to find out whether the planned mode of delivery is associated with neurodevelopmental outcome during the first year of life in twins. A prospective cohort study was conducted to evaluate the short- and long-term outcomes of twin pregnancy in Seoul National University Hospital. Twins were divided into 2 groups according to the attempted mode of delivery: PVD and PCS. Cases with emergency cesarean section due to fetal distress, major congenital anomaly and twin specific complications such as twin-to-twin transfusion syndrome and one fetal demise were excluded. The neurodevelopmental outcome was evaluated using the Korean - Ages and Stages Questionnaire (K-ASQ). K-ASQ is a Korean version of ASQ modified by standardization in Korea. It is approved as a reliable test that can monitor developmental status with a parent-completed questionnaire form. The abnormal K-ASQ score was defined as the score below 2 standard deviations from the mean for each infant age. Chi-square test, Fisher’s exact test, and Mann-Whitney U test were used as appropriate. We also performed a multivariable analysis. From May 2016 to November 2017, 256 women with twin pregnancy delivered at 27 to 40 weeks of gestation. Among them, 176 women (352 neonates) including 123 women of PVD (246 neonates, 69.9%) and 53 women of PCS (106 neonates, 30.1%) gave a consent and sent a complete questionnaire at least one time. There were no significant differences in demographic characteristics between two groups except the frequency of assisted reproduction (67.5% in PVD; 79.2% in PCS, p=.026) and vertex presented fetuses at delivery [79.3% (195/246) in PVD; 39.6% (42/106) in PCS, p<.001]. No significant differences were found in the rate of twins with one or more abnormal K-ASQ domains between PVD and PCS. After adjustment for the conception method and presentation at the time of delivery, the result showed no difference between two groups. (4 months, 10.2% vs. 11.4%, p=.862; 6 months, 7.0% vs. 11.5%, p=.417; 12 months, 10.3% vs. 14.3%, p=.532) As compared to PCS, PVD in twin pregnancy had no harmful effect on neurodevelopmental outcome during the first year of life, vaginal delivery with cephalic presentation of 1st twin can be encouraged.