Planned Cesarean or planned vaginal delivery for twins: secondary analysis of randomized controlled trial. (1st April 2021)

• Record Type: Journal Article
• Authors: Zafarmand, M. H.; Goossens, S. M. T. A.; Tajik, P.; Bossuyt, P. M. M.; Asztalos, E. V.; Gardener, G. J.; Willan, A. R.; Roumen, F. J. M. E.; Mol, B. W.; Barrett, Y. (Jon)
• Other Names: Barrett JF investigator.; Allen AC investigator.; Armson BA investigator.; Asztalos EV investigator.; Farrell S investigator.; Gafni A investigator.; Hanigsberg JE investigator.; Hannah ME investigator.; Hutton EK investigator.; Joseph KS investigator.; Leduc L investigator.; Mason D investigator.; Ohlsson A investigator.; Okun N investigator.; Ross S investigator.; Sanchez JJ investigator.; Willan AR investigator.; Bracken M investigator.; Crowley P investigator.; Donner A investigator.; Duley L investigator.; Ehrenkranz R investigator.; Thorpe K investigator.; Castaldi JL investigator.; Bertin MS investigator.; Partida Y investigator.; Galimberti D investigator.; Messina A investigator.; Voto LS investigator.; Voto GN investigator.; Prieto MJ investigator.; Buraschi F investigator.; Sexer H investigator.; Palermo M investigator.; Varela DM investigator.; Savransky R investigator.; Dunaievsky A investigator.; Andina E investigator.; Laterra C investigator.; Susacasa S investigator.; Frailuna MA investigator.; Almansa SR investigator.; Barrere MB investigator.; García H investigator.; Rivero M investigator.; Gomez EE investigator.; Schinini J investigator.; Ahlbom M investigator.; Aguirre JD investigator.; Martín Rde L investigator.; Videla A investigator.; Mesas W investigator.; Arias C investigator.; Castagnola MC investigator.; Gorostiaga RA investigator.; Curioni M investigator.; Mohedano M investigator.; Dip V investigator.; Roque A investigator.; Duhalde EM investigator.; Dodd J investigator.; Deussen A investigator.; Crowther C investigator.; Gardener G investigator.; Chaplin J investigator.; Wilkins D investigator.; Mahomed K investigator.; Green A investigator.; Baade R investigator.; Haran M investigator.; Hanafy A investigator.; Davis G investigator.; Roberts L investigator.; Tucker S investigator.; Duncan C investigator.; Watson D investigator.; Lawrence A investigator.; Laubach M investigator.; Breugelmans R investigator.; Calderon I investigator.; Martins A investigator.; Magalhães C investigator.; Cecatti JG investigator.; Surita FG investigator.; Rosado L investigator.; Vidal AC investigator.; de Souza GR investigator.; Maia Filho NL investigator.; Santana DS investigator.; de Sa RA investigator.; Marcolino L investigator.; Marques CC investigator.; Zanella PL investigator.; Milan C investigator.; Bollis MD investigator.; Steibel G investigator.; Ayub AC investigator.; Moreira S investigator.; Lima AC investigator.; Scavuzzi A investigator.; de Souza AS investigator.; de Moraes Filho OB investigator.; Carvalho SA investigator.; Bornia RG investigator.; da Silva NR investigator.; Spinola R investigator.; Lopes LM investigator.; Sass N investigator.; Korkes H investigator.; Chalem E investigator.; Yokota EJ investigator.; Silveira MR investigator.; Wood S investigator.; Miller L investigator.; McLeod L investigator.; Armson BA investigator.; Fanning C investigator.; Mueller V investigator.; Gregorovich S investigator.; Moore E investigator.; Gratton R investigator.; Kennedy L investigator.; Scheufler P investigator.; Reid D investigator.; Klam S investigator.; Daitchman R investigator.; Farquharson D investigator.; Harrison K investigator.; Kulkarni R investigator.; Scarfone R investigator.; Laplante J investigator.; Carson G investigator.; Williams S investigator.; Rosman D investigator.; Nemtean D investigator.; Olatunbosun F investigator.; Pierson K investigator.; Crane J investigator.; Hutchens D investigator.; Okun N investigator.; Zaltz A investigator.; Brown M investigator.; Ornstein M investigator.; Visram S investigator.; Bordin J investigator.; Siurna H investigator.; Petruskavich S investigator.; Gagnon A investigator.; Lee JM investigator.; Fernandez A investigator.; Kaye S investigator.; Haslauer KA investigator.; Cundiff G investigator.; Gomez R investigator.; Kusanovic JP investigator.; Neculman KS investigator.; Valenzuela LL investigator.; Leiva EM investigator.; Cabrera JG investigator.; Ravanal MM investigator.; Orrego RS investigator.; Matijevic R investigator.; Makhlouf A investigator.; Saber O investigator.; Abdelradey T investigator.; Kirss F investigator.; Rull K investigator.; Vaas P investigator.; Hopp H investigator.; Nonnenmacher A investigator.; Michaelis S investigator.; Hasbargen U investigator.; Delius M investigator.; Antsaklis A investigator.; Drakakis P investigator.; Major T investigator.; Bartha T investigator.; Salim R investigator.; Harel L investigator.; Chayen B investigator.; Siev S investigator.; Hallak M investigator.; Mei‐Dan E investigator.; Gonen R investigator.; Wolff L investigator.; Sadan O investigator.; Mansour‐Schwake D investigator.; Petchinkin L investigator.; Hakim M investigator.; Perlitz Y investigator.; Ben‐Ami M investigator.; Pansky S investigator.; Simms‐Stewart D investigator.; Wilson M investigator.; El‐Zibdeh M investigator.; AlFaris L investigator.; Heres M investigator.; Sluis A investigator.; Roumen FJ investigator.; Rinkens J investigator.; Willekes C investigator.; Alleman S investigator.; van Zandvoort SG investigator.; Porath MM investigator.; Verhoeven C investigator.; Mol BW investigator.; Radfar F investigator.; Khan S investigator.; Preis K investigator.; Swiatkowska‐Freund M investigator.; Krasomski G investigator.; Kesiak M investigator.; Krekora M investigator.; Zych K investigator.; Wilczynski J investigator.; Breborowicz G investigator.; Dera A investigator.; Ur Rahman S investigator.; Al‐Jassim AA investigator.; Stamatian F investigator.; Caracostea G investigator.; Gojnic M investigator.; Fazlagic A investigator.; Perovic M investigator.; Vasiljevic B investigator.; Stefanovic T investigator.; Gonce A investigator.; Rodriguez SH investigator.; Massanes M investigator.; Moratonas EC investigator.; Rodriguez CR investigator.; Martinez SA investigator.; Llurba E investigator.; Franch AS investigator.; de la Calle M investigator.; Dans F investigator.; Sancha M investigator.; Lopez S investigator.; Palomo ML investigator.; Del Valle MD investigator.; Martín MN investigator.; Delgado CL investigator.; Fournier MC investigator.; Ojutiku D investigator.; Masuku M investigator.; Goodsell K investigator.; Southam D investigator.; Tuffnell D investigator.; Germaine T investigator.; Palethorpe R investigator.; Farrar D investigator.; Wright J investigator.; Al‐Taher H investigator.; Meehan H investigator.; Bricker L investigator.; Dower M investigator.; Houghton G investigator.; Pascall A investigator.; Longworth H investigator.; Sau A investigator.; Thornton J investigator.; Fisher J investigator.; Houda M investigator.; Simm A investigator.; Bugg G investigator.; Deshpande R investigator.; Davis Y investigator.; Holloway F investigator.; Welch R investigator.; Hollands H investigator.; Young P investigator.; Hinshaw K investigator.; Bargh A investigator.; Edmundson D investigator.; Cameron H investigator.; Alonso J investigator.; Austt AG investigator.; Ortiz A investigator.; Burgis J investigator.; Brown S investigator.; Gregg A investigator.; Borowski K investigator.; Fleener D investigator.; Deaver J investigator.; Sumersille M investigator.; Aronoff C investigator.; Bland K investigator.; Kontopoulos E investigator.; Rivero Y investigator.; Lovett SM investigator.; Zatinsky S investigator.; Diogo M investigator.; Coonrod DV investigator.; Jimenez BF investigator.; Chan S investigator.; Hewson SA investigator.; Hoac T investigator.; Kowal C investigator.; Mangoff K investigator.; Mergler S investigator.; Shi M. investigator.;
• Is Part Of: Ultrasound in obstetrics & gynecology. Volume 57:Number 4(2021)
• Page Start: 582
• Page End: 591
• Publication Date: 2021-04-01
• Subjects: gestational age -- mode of delivery -- multiple pregnancy -- twins; Ultrasonics in obstetrics -- Periodicals; Generative organs, Female -- Diseases -- Diagnosis -- Periodicals; Diagnosis, Ultrasonic -- Periodicals; Genital Diseases, Female -- ultrasonography -- Periodicals; Ultrasonography, Prenatal -- Periodicals; 618.047543
• DOI: 10.1002/uog.21907
• Languages: English
• ISSNs: 0960-7692

Abstract

ABSTRACT: Objective: To evaluate whether there is a differential benefit of planned Cesarean delivery (CD) over planned vaginal delivery (VD) in women with a twin pregnancy and the first twin in cephalic presentation, depending on prespecified baseline maternal and pregnancy characteristics, and/or gestational age (GA) at delivery. Methods: This was a secondary analysis of the Twin Birth Study, which included 2804 women with a twin pregnancy and the first twin (Twin A) in cephalic presentation between 32 + 0 and 38 + 6 weeks' gestation at 106 centers in 25 countries. Women were assigned randomly to either planned CD or planned VD. The main outcome measure was composite adverse perinatal outcome, defined as the occurrence of perinatal mortality or serious neonatal morbidity in at least one twin. The baseline maternal and pregnancy characteristics (markers) considered were maternal age, parity, history of CD, use of antenatal corticosteroids, estimated fetal weight (EFW) of Twin A, EFW of Twin B, > 25% difference in EFW between the twins, presentation of Twin B, chorionicity on ultrasound, method of conception, complications of pregnancy, ruptured membranes at randomization and GA at randomization. Separate logistic regression models were developed for each marker in order to model composite adverse perinatal outcome as a function of the specific marker, planned delivery mode and the interaction between these two terms. In addition, multivariable logistic regression analysis with backward variable elimination was performed separately in each arm of the trial. The association between planned mode of delivery and composite adverse perinatal outcome, according to GA at delivery, was assessed using logistic regression analysis. Results: Of the 2804 women initially randomized, 1391 were included in each study arm. None of the studied baseline markers was associated with a differential benefit of planned CD over planned VD in the rate of composite adverse perinatal outcome. GA at delivery was associated differentially with composite adverse perinatal outcome in the treatment arms ( P for interaction < 0.001). Among pregnancies delivered at 32 + 0 to 36 + 6 weeks, there was a trend towards a lower rate of composite adverse perinatal outcome in those in the planned‐VD group compared with those in planned‐CD group (29 (2.2%) vs 48 (3.6%) cases; odds ratio (OR) 0.62 (95% CI, 0.37–1.03)). In pregnancies delivered at or after 37 + 0 weeks, planned VD was associated with a significantly higher rate of composite adverse perinatal outcome, as compared with planned CD (23 (1.5%) vs 10 (0.7%) cases; OR, 2.25 (95% CI, 1.06–4.77)). Conclusion: The perinatal outcome of twin pregnancies with the first twin in cephalic presentation may differ depending on GA at delivery and planned mode of delivery. At 32–37 weeks, planned VD seems to be favorable, while, from around 37 weeks onwards, planned CD might be safer. The absolute risks of adverse perinatal outcomes at term are low and must be weighed against the increased maternal risks associated with planned CD. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.