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#Grand Rounds

Is there a Benefit to Cesarean Section vs Vaginal Delivery for Preterm Twins?

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BACKGROUND AND PURPOSE:

  • There are studies suggesting planned cesarean may be safer for twin delivery
  • Sentilhes et al. (Obstetrics & Gynecology, 2018) examined neonatal and 2-year outcomes for preterm twins born after planned vaginal delivery

METHODS:

  • Secondary analysis of a prospective population-based cohort study: Epidémiologique sur les Petits Ages Gestationnels 2 study
    • Women with preterm cephalic first twins delivered after preterm labor or preterm prelabor rupture of membranes (PPROM)
    • 24 to 34 weeks
  • Exposure: Planned route of delivery
  • Planned vaginal delivery
    • Vaginal delivery or cesarean delivery performed during labor
  • Planned cesarean delivery
    • Cesarean performed
      • During labor for the indication of preterm twins or
      • Before labor whatever the indication
    • Primary Outcomes: Survival at discharge
    • Additional outcomes
      • Survival at discharge without severe morbidity | Survival at 2 years of corrected age without neurosensory impairment
    • Twin outcomes assessed independently

RESULTS:

  • 276 women planned vaginal delivery group | 107 women planned cesarean delivery group
  • There was no significant difference between groups for the following
    • Survival at discharge (planned vaginal vs cesarean)
      • 1st twin: 97.7% vs 98.3%
      • 2nd twin: 95.6% vs 97.1%
    • Survival at discharge without severe morbidity (planned vaginal vs cesarean)
      • 1st twin: 91.6% vs 88.8%
      • 2nd twin: 90.3% vs 84.5%
    • Survival at 2 years of corrected age without neurosensory impairment (planned vaginal vs cesarean)
      • 1st twin: 96.0% vs 95.4%
      • 2nd twin: 92.9% vs 90.8%

CONCLUSION:

  • Planned cesarean delivery was not associated with improved outcomes for preterm twins when first twin is cephalic
  • Power was insufficient to determine potentially clinically meaningful differences particularly for more rare outcomes

Learn More – Primary Sources:

Planned Mode of Delivery of Preterm Twins and Neonatal and 2-Year Outcomes

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Related ObG Topics:

What is the Actual Relative Risk of Preeclampsia in Twins Compared to Singletons?
Do Twin-Specific Nomograms Really Make a Difference?
Does the Timing of a Loss of One Twin Affect the Risk for Preterm Birth?
Can Obstetric History Predict Preterm Birth Risk in Twins?

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