Neonatal and Maternal Outcomes in Spontaneously-Conceived Twin PregnanciesAccording to Mode of Delivery.

Samantha Mc Kenzie Stancu,Manuela Cristina Russu

doi:10.3897/folmed.62.e49276

Samantha Mc Kenzie Stancu, Manuela Cristina Russu

Open Access

https://doi.org/10.3897/folmed.62.e49276

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Abstract

Appropriate intrapartum conduct in a twin delivery remains a challenging aspect of obstetric practice. The objective of this study was to compare neonatal and maternal outcomes in twin pregnancies according to mode of delivery. This is a single centre retrospective cohort study of all consecutive spontaneously-conceived twin deliver-ies (≥ 24 weeks, estimated fetal weight ≥ 500 grams) over a nine-year period between 01/01/2007 - 31/12/2016 at a tertiary-level centre. Neonatal outcomes included survival, APGAR score, prematurity-associated pathology (PAP), admission to the neonatal intensive care unit (NICU) and length of stay (LOS). Maternal outcomes included postpartum complications and LOS. Statistical analysis comprised Chi-square test with subsequent p-value and odds-ratio with 95% confidence interval. Statistical significance was set at p<0.05. A total of 173 consecutive women with spontaneously-conceived twin deliveries were enrolled in this study, 129 (74.6%) women delivered by caesarean section (CS). The success rate of vaginal delivery (VD) was 93.6% (44/47). A strong statistical correlation was identified between CS and NICU admission; 53.2% vs. 1.5% (p=0.0001). Neonatal LOS in the NICU was significantly longer in the CS group. Prematurity-associated pathology (PAP) was noted in 75 pairs of twins (75/173); 61 pairs were delivered by CS, bearing strong statistical significance (p<0.0001). Postpartum complications occurred in 14.7% of CS compared to 13.6% of VDs. Neonates delivered by CS had a higher rate of PAP, NICU admission, lower birth weight and longer LOS. This study showed that VD is safe, especially when the first twin is in cephalic presentation.

Highlights

Appropriate intrapartum conduct in a twin delivery remains a challenging aspect of obstetric practice
Vaginal delivery was undertaken in 81.8% of intrauterine fetal death (IUFD) cases (OR: 0.10, 95%CI: 0.02-2.42, p=0.0015)
Further larger prospective multicentric studies are needed to conclude whether vaginal delivery (VD) is safer than caesarean section (CS) when the leading twin is in vertex presentation

Summary

Introduction

Appropriate intrapartum conduct in a twin delivery remains a challenging aspect of obstetric practice. Postpartum complications occurred in 14.7% of CS compared to 13.6% of VDs. Conclusion: Neonates delivered by CS had a higher rate of PAP, NICU admission, lower birth weight and longer LOS. Neonatal and Maternal Outcomes in Spontaneously-Conceived Twin Pregnancies of complications during pregnancy and delivery compared to their counterparts carrying a singleton pregnancy.[6,7,8,9,10] This increase in complications is largely attributable to the higher incidence of premature delivery in twin pregnancies and its associated morbidity.[7] Prematurity-induced morbidity encompasses respiratory distress syndrome, transient tachypnea of the newborn, neonatal seizures, persistent fetal circulation, necrotising enterocolitis and intraventricular haemorrhage, even when birth weight exceeds 2500 grams.[11,12]

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