Neonatal outcomes of preterm twins according to mode of birth and presentation. (4th March 2018)

• Record Type: Journal Article
• Authors: Hunter, Tiffany; Shah, Jyotsna; Synnes, Anne; Shivananda, Sandesh; Ryan, Greg; Shah, Prakesh S.; Murphy, Kellie E.
• Is Part Of: Journal of maternal-fetal & neonatal medicine. Volume 31:Number 5(2018)
• Page Start: 682
• Page End: 688
• Publication Date: 2018-03-04
• Subjects: Infant -- premature -- multiple pregnancy -- mortality -- neurological injury -- respiratory distress syndrome -- mode of delivery; Obstetrics -- Periodicals; Perinatology -- Periodicals; Infants (Newborn) -- Diseases -- Periodicals; Neonatology -- Periodicals; 618.2
• DOI: 10.1080/14767058.2017.1295441
• Languages: English
• ISSNs: 1476-7058

Abstract

Abstract: Purpose: To compare neonatal outcomes of twins delivered <33 weeks' gestation in tertiary centers in Canada according to the mode of birth and presentation. Materials and methods: This retrospective cohort from the Canadian Neonatal Network database studied preterm twins born from 24 + 0 to 32 + 6 weeks' gestation between 2005 and 2012. Twins were grouped by the mode of birth: both vaginal, combined vaginal/cesarean section (CS), and both CS. Additionally, twins were grouped by the mode of presentation: both vertex, vertex/breech, breech/vertex, and both breech. The primary outcome was a composite of mortality or severe neonatal morbidity (severe neurological injury [intraventricular hemorrhage grade 3/4 or periventricular leukomalacia], bronchopulmonary dysplasia, retinopathy of prematurity, and necrotizing enterocolitis). Results: Of the 6636 twins, 1934 (29%) were delivered vaginally, 418 (6%) by combined vaginal birth/CS, and 4284 (65%) were born by CS. The composite did not differ between the groups. However, severe neurological injury was decreased (adjusted odds ratio [AOR], 0.77; 95% confidence interval [CI], 0.61–0.98) and respiratory distress syndrome (AOR, 1.34; 95%CI, 1.15–1.56) was increased when both the twins were delivered by CS. Conclusions: Preterm twin infants born via CS experienced less severe neurological injury when compared to those delivered vaginally, but had an increase in respiratory distress syndrome.