Loïc Sentilhes1, Anne Oppenheimer2, Anne-Charlotte Bouhours3, Estelle Normand2, Bassam Haddad4, Philippe Descamps3, Loïc Marpeau5, François Goffinet6, Gilles Kayem2. 1. Department of Obstetrics and Gynecology, Angers University Hospital, Angers, France. Electronic address: loicsentilhes@hotmail.com. 2. Department of Obstetrics and Gynecology, Départment Hospitalo Universitaire "Risks and Pregnancy" Louis Mourier Hospital, Assistance Publique-Hôpitaux de Paris, University Paris-Diderot, Colombes, France. 3. Department of Obstetrics and Gynecology, Angers University Hospital, Angers, France. 4. Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal de Créteil, Assistance Publique-Hôpitaux de Paris, Créteil, France. 5. Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France. 6. Department of Obstetrics and Gynecology, Maternity Port-Royal Hospital, Cochin Assistance Publique-Hôpitaux de Paris, University René Descartes, Paris, France.
Abstract
OBJECTIVE: The objective of the study was to compare neonatal mortality and morbidity in very preterm twins with the first twin in cephalic presentation in hospitals with a policy of planned vaginal delivery (PVD) and those with a policy of planned cesarean delivery (PCD). STUDY DESIGN: Women with preterm cephalic first twins delivered after preterm labor and/or premature preterm rupture of membranes from 26(0/7) to 31(6/7) weeks of gestation were identified from the databases of 6 perinatal centers and classified as PVD or PCD according to the center's management policy from 1999 to 2010. Severe neonatal morbidity was defined as any of the following: intraventricular hemorrhage grades 3-4, periventricular leukomalacia, necrotizing enterocolitis, bronchopulmonary dysplasia, and hospital death. The independent effect of the planned mode of delivery, defined by the center's management policy, was tested and quantified with a 2-level multivariable logistic regression. RESULTS: The PVD group included 248 women, and the PCD group 63. Maternal characteristics did not differ between the 2 groups. The rate of vaginal delivery was 85.9% (213 of 248) vs 20.6% (13 of 63) (P < .001), and the rate of cesarean delivery for the second twin was 1.6% (4 of 248) vs 4.8% (3 of 63) (P = .13) for PVD and PCD. PVD had no independent effect on either newborn hospital mortality or severe neonatal composite morbidity. CONCLUSION: A policy of planned vaginal delivery of very preterm twins with the first twin in cephalic presentation does not increase either severe neonatal morbidity or mortality.
OBJECTIVE: The objective of the study was to compare neonatal mortality and morbidity in very preterm twins with the first twin in cephalic presentation in hospitals with a policy of planned vaginal delivery (PVD) and those with a policy of planned cesarean delivery (PCD). STUDY DESIGN:Women with preterm cephalic first twins delivered after preterm labor and/or premature preterm rupture of membranes from 26(0/7) to 31(6/7) weeks of gestation were identified from the databases of 6 perinatal centers and classified as PVD or PCD according to the center's management policy from 1999 to 2010. Severe neonatal morbidity was defined as any of the following: intraventricular hemorrhage grades 3-4, periventricular leukomalacia, necrotizing enterocolitis, bronchopulmonary dysplasia, and hospital death. The independent effect of the planned mode of delivery, defined by the center's management policy, was tested and quantified with a 2-level multivariable logistic regression. RESULTS: The PVD group included 248 women, and the PCD group 63. Maternal characteristics did not differ between the 2 groups. The rate of vaginal delivery was 85.9% (213 of 248) vs 20.6% (13 of 63) (P < .001), and the rate of cesarean delivery for the second twin was 1.6% (4 of 248) vs 4.8% (3 of 63) (P = .13) for PVD and PCD. PVD had no independent effect on either newborn hospital mortality or severe neonatal composite morbidity. CONCLUSION: A policy of planned vaginal delivery of very preterm twins with the first twin in cephalic presentation does not increase either severe neonatal morbidity or mortality.
Authors: Jin-Wen Zhang; Ware Branch; Matthew Hoffman; Ank De Jonge; Sheng-Hui Li; James Troendle; Jun Zhang Journal: BMJ Open Date: 2018-08-05 Impact factor: 2.692