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)
    • 1^st twin: 97.7% vs 98.3%
    • 2^nd twin: 95.6% vs 97.1%
  • Survival at discharge without severe morbidity (planned vaginal vs cesarean)
    • 1^st twin: 91.6% vs 88.8%
    • 2^nd twin: 90.3% vs 84.5%
  • Survival at 2 years of corrected age without neurosensory impairment (planned vaginal vs cesarean)
    • 1^st twin: 96.0% vs 95.4%
    • 2^nd 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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Can Obstetric History Predict Preterm Birth Risk in Twins?