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

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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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