Neonatal outcomes according to actual delivery mode after planned vaginal delivery in women with a twin pregnancy

Abstract

ObjectiveTo compare, in women with twin pregnancy with the first twin in cephalic position, neonatal morbidity and mortality rates after actual 1) Vaginal delivery (VD) both twins versus 2) unplanned Cesarean Delivery (CD) of both twins and 3) after VD of twin A and CD of twin B (combined delivery). Study DesignWe describe a nationwide cohort study of women pregnant with twins who planned to deliver vaginally between 32+0 - 41+6 weeks with the first twin in cephalic position, between 2000–2012 in the Netherlands.We used multivariate logistic regression analysis to compare neonatal morbidity and mortality according to actual mode of delivery, overall, and for preterm and term groups separately. ResultsWe included 19,723 women of whom 15,785 women (80.0 %) delivered both twins by VD, 2926 (14.6 %) delivered both twins by unplanned CD, and 1012 (5.1 %) women delivered by combined delivery.After unplanned CD of both twins compared to VD more perinatal mortality (1 or more twins affected) was seen (adjusted Odds Ratio (aOR) 2.23 (95 % CI 1.26–4.129)), as was ‘Asphyxia related morbidity’ (aOR 2.44 (95 % CI 1.80−3.31), ‘other morbidity’ (aOR 1.34 (95 %CI 1.17−1.54), and ‘any morbidity or mortality’ (aOR1.39 (95 % CI 1.22–1.58)). Less ‘Trauma- related morbidity’ after unplanned CD vs. VD (aOR 0.11 (95 % 0.02−0.79)) was seen.After combined delivery vs. VD, more perinatal mortality (aOR 7.75 (95 % CI 4.51−13.34)), more Asphyxia- related morbidity (aOR 6.67 (95 % CI4.91−9.06), ‘prematurity related morbidity’ (aOR 2.11 (95 % CI 1.59−2.79) ‘other morbidity’ (aOR 2.01 (95 % CI 1.65−2.46), and ‘any morbidity or mortality’ (aOR 2.44 (95 % CI 2.04−2.91)) were noted. All outcomes expect ‘trauma-associated morbidity’ were more increased for twin B as compared to twin A. ConclusionAfter unplanned CD of both twins vs. VD of both twins, a twofold increase in neonatal mortality is noted. Combined delivery vs. VD of both twins is associated with a sevenfold increase in perinatal mortality and a five-fold increase in asphyxia-related outcomes. Twin A is more affected after unplanned CD of both twins, while twin B is more affected after combined delivery.