1. Is Cesarean Delivery Preferable in Twin Pregnancies at >=36 Weeks Gestation?
- Author
-
Jun Zhang, Zhong-Cheng Luo, Lu Chen, Hong Huang, Yu Dong, Ware Branch, Yu-Na Guo, and Zujing Yang
- Subjects
Physiology ,Maternal Health ,Twins ,lcsh:Medicine ,Blood Pressure ,Vascular Medicine ,Labor and Delivery ,0302 clinical medicine ,Pregnancy ,Infant Mortality ,Medicine and Health Sciences ,Birth Weight ,030212 general & internal medicine ,lcsh:Science ,Twin Pregnancy ,030219 obstetrics & reproductive medicine ,Multidisciplinary ,Vaginal delivery ,Obstetrics ,Pregnancy Outcome ,Gestational age ,Obstetrics and Gynecology ,Survival Rate ,Physiological Parameters ,Obstetric Procedures ,Hypertension ,Gestation ,Female ,Research Article ,Adult ,medicine.medical_specialty ,Birth weight ,Surgical and Invasive Medical Procedures ,Gestational Age ,03 medical and health sciences ,Young Adult ,Hypertensive Disorders in Pregnancy ,Intensive care ,medicine ,Genetics ,Humans ,Retrospective Studies ,Gynecology ,business.industry ,Cesarean Section ,Body Weight ,lcsh:R ,Infant, Newborn ,Biology and Life Sciences ,Neonates ,Infant ,Human Genetics ,medicine.disease ,Delivery, Obstetric ,Health Care ,Birth ,Intensive Care, Neonatal ,Pregnancy, Twin ,Women's Health ,Multiple birth ,lcsh:Q ,Health Statistics ,Morbidity ,business ,Developmental Biology - Abstract
Background The optimal mode of delivery in twin pregnancies remains controversial. A recent randomized trial did not find any benefit of planned cesarean vs. vaginal delivery at 32–38 weeks gestation, but the trial was not powered to detect a moderate effect. We aimed to evaluate the impact of cesarean delivery on perinatal mortality and severe neonatal morbidity in twin pregnancies at ≥32 weeks through a large database exploration approach with the power to detect moderate risk differences. Methods In a retrospective birth cohort study using the U.S. matched multiple births, 1995–2000 (the available largest multiple birth dataset), we compared perinatal outcomes in twins (n = 181,810 pregnancies) delivered at 32–41 weeks gestation without congenital anomalies. The primary outcome was a composite of perinatal death and severe neonatal morbidity. Cox regression was used to estimate the adjusted hazard ratio (aHR) controlling for the propensity to cesarean delivery, fetal characteristics (sex, birth weight, birth weight discordance, same-sex twin or not) and twin-cluster level dependence. Prospective risks were calculated using the fetuses-at-risk denominators. Results The overall rates of the primary outcome were slightly lower in intended cesarean (6.20%) vs. vaginal (6.45%) deliveries. The aHRs of the primary outcome were in favor of vaginal delivery at 32 (aHR = 1.06, p = 0.03) or 33 (aHR = 1.22, p
- Published
- 2016