1. Mode of delivery and neonatal outcomes in extremely preterm Vertex/nonVertex twins
- Author
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Liran Hiersch, Prakesh S. Shah, Faiza Khurshid, Edith Masse, Kellie Murphy, Sarah D. McDonald, George Carson, Jon Barrett, Nir Melamed, Joseph Ting, Zenon Cieslak, Rebecca Sherlock, Ayman Abou Mehrem, Jennifer Toye, Carlos Fajardo, Zarin Kalapesi, Jaya Bodani, Koravangattu Sankaran, Sibasis Daspal, Mary Seshia, Deepak Louis, Ruben Alvaro, Amit Mukerji, Orlando Da Silva, Mohammad Adie, Kyong-Soon Lee, Michael Dunn, Brigitte Lemyre, Ermelinda Pelausa, Keith Barrington, Anie Lapoint, Guillaume Ethier, Christine Drolet, Bruno Piedboeuf, Martine Claveau, Marc Beltempo, Valerie Bertelle, Roderick Canning, Hala Makary, Cecil Ojah, Luis Monterrosa, Julie Emberley, Jehier Afifi, Andrzej Kajetanowicz, Shoo K. Lee, Haim Abenhaim, James Andrews, Anthony Armson, Francois Audibert, Khalid Aziz, Marilyn Ballantyne, Anick Berard, Lucie Blais, Alan Bocking, Jason Burrows, Kimberly Butt, Nils Chaillet, Sue Chandra, Paige Church, Kevin Coughlin, Joan Crane, Dianne Creighton, Thierry Daboval, Leanne Dahlgren, Cecilia de Cabo, Akhil Deshpandey, Kimberly Dow, Salhab el Helou, Darine El-Chaar, Walid El-Naggar, Jonathan Foster, Robert Gagnon, Rob Gratton, Victor Han, Adele Harrison, Shabih Hasan, Michael Helewa, Matthew Hicks, K.S. Joseph, Thierry Lacaze-Masmonteil, Abhay Lodha, Thuy Mai Luu, Linh Ly, Annette Majnemer, Isabelle Marc, Doug McMillan, Amy Metcalfe, Diane Moddemann, Michelle Morais, William Mundle, Lynn Murphy, Anne-Monique Nuyt, Chuks Nwaesei, Karel O’Brien, Martin Offringa, Annie Ouellet, Jean-Charles Pasquier, Petros Pechlivanoglou, Elodie Portales-Casamar, Shahirose Premji, Pramod Puligandla, Eleanor Pullenayegum, Amber Reichert, Kate Robson, Carol Schneider, Vibhuti Shah, Sandesh Shivananda, Nalini Singhal, Erik Skarsgard, Amanda Skoll, Graeme Smith, Anne Synnes, Katherine Thériault, Suzanne Tough, Jagdeep Ubhi, Michael Vincer, Wendy Whittle, Hilary Whyte, Doug Wilson, Stephen Wood, Philip Ye, Wendy Yee, and Jill Zwicker
- Subjects
Adult ,Male ,medicine.medical_specialty ,Birth trauma ,Infant, Premature, Diseases ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Intensive care ,Birth Injuries ,Diseases in Twins ,medicine ,Humans ,030212 general & internal medicine ,Breech Presentation ,Retrospective Studies ,030219 obstetrics & reproductive medicine ,Cesarean Section ,Obstetrics ,Vaginal delivery ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,Retrospective cohort study ,Delivery, Obstetric ,medicine.disease ,Trial of Labor ,3. Good health ,Treatment Outcome ,Case-Control Studies ,Infant, Extremely Premature ,Relative risk ,Pregnancy, Twin ,Premature Birth ,Gestation ,Female ,Vertex Presentation ,Presentation (obstetrics) ,business - Abstract
Background One of the controversies in the management of twin gestations relates to mode of delivery, especially when the second twin is in a nonvertex presentation (Vertex/nonVertex pairs) and birth is imminent at extremely low gestation. Objective We hypothesized that, for Vertex/nonVertex twins born before 28 weeks’ gestation, cesarean delivery would be associated with a lower risk of adverse neonatal outcomes than trial of vaginal delivery. Our aim was to test this hypothesis by comparing the neonatal outcomes of Vertex/nonVertex twins born before 28 weeks’ gestation by mode of delivery using a large national cohort. Study Design This work is a retrospective cohort study of all twin infants born at 240/7 to 276/7 weeks’ gestation and admitted to level III neonatal intensive care units participating in the Canadian Neonatal Network (2010–2017). Exposure is defined a trial of vaginal delivery for Vertex/nonVertex twins. Nonexposed (control) groups are defined as cases where both twins were delivered by cesarean delivery, either in vertex or nonvertex presentation (control group 1) or owing to the nonvertex presentation of the first twin (control group 2). Outcome measures are defined as a composite of neonatal death, severe neurologic injury, or birth trauma. Results A total of 1082 twin infants (541 twin pairs) met the inclusion criteria: 220 Vertex/nonVertex pairs, of which 112 had a trial of vaginal delivery (study group) and 108 had cesarean delivery for both twins (control group 1); 170 pairs with the first twin in nonvertex presentation, all of which were born by cesarean delivery (control group 2); and 151 pairs with both twins in vertex presentation (vertex or nonvertex). In the study group, the rate of urgent cesarean delivery for the second twin was 30%. The rate of the primary outcome in the study group was 42%, which was not significantly different compared with control group 1 (37%; adjusted relative risk, 0.93; 95% confidence interval, 0.71–1.22) or control group 2 (34%; adjusted relative risk, 1.20; 95% confidence interval, 0.92–1.58). The findings remained similar when outcomes were analyzed separately for the first and second twins. Conclusion For preterm Vertex/nonVertex twins born at
- Published
- 2021