The influence of presentation and method of delivery on neonatal mortality and infant neurodevelopmental outcome in nondiscordant low-birthweight ( < 2500 g) twin gestations.

The effects of birth order, presentation and method of delivery on neonatal mortality and neurodevelopmental outcome in nondiscordant low birthweight ( < 2500 g) twin gestations were evaluated. Sixty-four sets of twins were included in the study; 29 sets were in vertex/vertex presentation (Group I), 25 sets in vertex/breech (Group II) and in 10 pregnancies the first twin was nonvertex (Group III). The rate of favorable neonatal outcome (survival and normal neurodevelopmental outcome after a 2-year follow-up) was lower in pregnancies in which at least one twin was in nonvertex presentation (50/70 vs. 52/58 P = 0.02). However, after adjustment by multiple logistic regression analysis for the effects of gestational age, birthweight, birth order and educational level of the mother, this difference was not statistically significant (odds ratio = 0.6; 95% confidence interval 0.44 to 5.9; P = 0.5). In pregnancies in which at least one of the twins was in nonvertex presentation, delivery by cesarean section did not affect the rate of favorable neonatal outcome (odds ratio = 1.8; 95% confidence interval 0.48 to 12.9; P = 0.8). The results of this study suggest that in low birthweight twin gestations, method of delivery in relation to fetal presentation has little or no effect on neonatal mortality and subsequent neonatal neurodevelopmental outcome.