Elizabeth V Asztalos1, Mary E Hannah2, Eileen K Hutton3, Andrew R Willan4, Alexander C Allen5, B Anthony Armson6, Amiram Gafni7, K S Joseph8, Arne Ohlsson9, Susan Ross10, J Johanna Sanchez11, Kathryn Mangoff11, Jon F R Barrett12. 1. Department of Newborn and Developmental Pediatrics, Sunnybrook Health Sciences Center, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada. Electronic address: elizabeth.asztalos@sunnybrook.ca. 2. Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada. 3. Midwifery Education Program, McMaster University, Hamilton, Ontario, Canada. 4. Department of Ontario Child Health Support Unit, SickKids Research Institute, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. 5. Department of Pediatrics, Izaak Walton Killam Health Center, Dalhousie University, Halifax, Nova Scotia, Canada. 6. Department of Obstetrics and Gynecology, Izaak Walton Killam Health Center, Dalhousie University, Halifax, Nova Scotia, Canada. 7. Center for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. 8. Department of Obstetrics and Gynecology and the School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada. 9. Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. 10. Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada. 11. Center for Mother, Infant, and Child Research, Sunnybrook Health Sciences Center, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada. 12. Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.
Abstract
BACKGROUND: The Twin Birth Study randomized women with uncomplicated pregnancies, between 32(0/7)-38(6/7) weeks' gestation where the first twin was in cephalic presentation, to a policy of either a planned cesarean or planned vaginal delivery. The primary analysis showed that planned cesarean delivery did not increase or decrease the risk of fetal/neonatal death or serious neonatal morbidity as compared with planned vaginal delivery. OBJECTIVE: This study presents the secondary outcome of death or neurodevelopmental delay at 2 years of age. STUDY DESIGN: A total of 4603 children from the initial cohort of 5565 fetuses/infants (83%) contributed to the outcome of death or neurodevelopmental delay. Surviving children were screened using the Ages and Stages Questionnaire with abnormal scores validated by a clinical neurodevelopmental assessment. The effect of planned cesarean vs planned vaginal delivery on death or neurodevelopmental delay was quantified using a logistic model to control for stratification variables and using generalized estimating equations to account for the nonindependence of twin births. RESULTS:Baseline maternal, pregnancy, and infant characteristics were similar. Mean age at assessment was 26 months. There was no significant difference in the outcome of death or neurodevelopmental delay: 5.99% in the planned cesarean vs 5.83% in the planned vaginal delivery group (odds ratio, 1.04; 95% confidence interval, 0.77-1.41; P = .79). CONCLUSION: A policy of planned cesarean delivery provides no benefit to children at 2 years of age compared with a policy of planned vaginal delivery in uncomplicated twin pregnancies between 32(0/7)-38(6/7)weeks' gestation where the first twin is in cephalic presentation.
RCT Entities:
BACKGROUND: The Twin Birth Study randomized women with uncomplicated pregnancies, between 32(0/7)-38(6/7) weeks' gestation where the first twin was in cephalic presentation, to a policy of either a planned cesarean or planned vaginal delivery. The primary analysis showed that planned cesarean delivery did not increase or decrease the risk of fetal/neonatal death or serious neonatal morbidity as compared with planned vaginal delivery. OBJECTIVE: This study presents the secondary outcome of death or neurodevelopmental delay at 2 years of age. STUDY DESIGN: A total of 4603 children from the initial cohort of 5565 fetuses/infants (83%) contributed to the outcome of death or neurodevelopmental delay. Surviving children were screened using the Ages and Stages Questionnaire with abnormal scores validated by a clinical neurodevelopmental assessment. The effect of planned cesarean vs planned vaginal delivery on death or neurodevelopmental delay was quantified using a logistic model to control for stratification variables and using generalized estimating equations to account for the nonindependence of twin births. RESULTS: Baseline maternal, pregnancy, and infant characteristics were similar. Mean age at assessment was 26 months. There was no significant difference in the outcome of death or neurodevelopmental delay: 5.99% in the planned cesarean vs 5.83% in the planned vaginal delivery group (odds ratio, 1.04; 95% confidence interval, 0.77-1.41; P = .79). CONCLUSION: A policy of planned cesarean delivery provides no benefit to children at 2 years of age compared with a policy of planned vaginal delivery in uncomplicated twin pregnancies between 32(0/7)-38(6/7)weeks' gestation where the first twin is in cephalic presentation.
Authors: Danielly S Santana; Carla Silveira; Maria L Costa; Renato T Souza; Fernanda G Surita; João P Souza; Syeda Batool Mazhar; Kapila Jayaratne; Zahida Qureshi; Maria H Sousa; Joshua P Vogel; José G Cecatti Journal: BMC Pregnancy Childbirth Date: 2018-11-20 Impact factor: 3.007
Authors: M H Zafarmand; S M T A Goossens; P Tajik; P M M Bossuyt; E V Asztalos; G J Gardener; A R Willan; F J M E Roumen; B W Mol; Y Jon Barrett Journal: Ultrasound Obstet Gynecol Date: 2021-04 Impact factor: 7.299