Grand Rounds

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

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

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

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^sttwin: 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%

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

Direct to Your Email/Text

Learn More »

< Previous

Next >