LISA RICE, ROBERT BONEBRAKE, MICHAEL BARSOOM, Creighton University, Obstetrics and Gynecology, Omaha, Nebraska OBJECTIVE: To evaluate the trends in delivery mode of twin gestations in the United States from 1990 and 2000 and neonatal outcomes. STUDY DESIGN: This is a population-based retrospective cohort study evaluating all twin deliveries in the US, occurring in 1990 and 2000, identified using the CDC/NCHS natality database. Exclusion criteria were EGA ! 24 weeks, !500 g, placenta previa and major fetal anomalies. Variables evaluated were maternal demographics, obstetric history, intrapartum and neonatal outcomes. Primary outcome was mode of delivery. Secondary outcomes included 5 minute Apgar !5, respiratory distress(RDS), need for ventilatory support, and birth injury. Descriptive statistics using two-tailed Chi-squared and Fisher’s exact tests were used with significance at p !0.05. RESULTS: 44,400 and 56,788 twin gestations from 1990 and 2000, respectively, were included. There were significantly more primary CS in 2000 regardless of fetal presentation. In 1990, there were significantly more infants with 5 minute Apgars ! 5. In 2000, there were significantly more cases of RDS, need for ventilatory support, and birth injury. Analyzing the data from 2000 by mode of delivery, CS was associated with a significant reduction in birth injuries and 5 minute Apgars !5 compared to vaginal delivery. This persisted when controlled for EGA. There was significantly more RDS and need for ventilatory support in the CS group, which persisted when controlled for presentation. CONCLUSION: This demonstrates the dramatic shift in the mode of delivery for twin gestations from 1990 to 2000, specifically in VTX/VTX twins. More twin gestations were delivered by CS in 2000, regardless of presentation. There was a significant rise in the number of CS performed for VTX/VTX presentation. CS was associated with a significant decrease in birth injuries and 5 minute Apgars ! than 5 compared to vaginal twins. There was noted to be an increase in RDS and ventilatory support in the CS group. Based on this data, CS in VTX/VTX twin gestations appear to be associated with fewer birth injuries and 5 minute Apgars !5.
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