Neonatal outcomes of preterm twins according to mode of birth and presentation

作者：Hunter Tiffany; Shah Jyotsna; Synnes Anne; Shivananda Sandesh; Ryan Greg; Shah Prakesh S; Murphy Kellie E^*

来源：Journal of Maternal-Fetal and Neonatal Medicine, 2018, 31(5): 682-688.

DOI：10.1080/14767058.2017.1295441

• Infant
• premature
• multiple pregnancy
• mortality
• neurological injury
• respiratory distress syndrome
• mode of delivery

Purpose: To compare neonatal outcomes of twins delivered <33 weeks' gestation in tertiary centers in Canada according to the mode of birth and presentation.Materials and methods: This retrospective cohort from the Canadian Neonatal Network database studied preterm twins born from 24+0 to 32+6 weeks' gestation between 2005 and 2012. Twins were grouped by the mode of birth: both vaginal, combined vaginal/cesarean section (CS), and both CS. Additionally, twins were grouped by the mode of presentation: both vertex, vertex/breech, breech/vertex, and both breech. The primary outcome was a composite of mortality or severe neonatal morbidity (severe neurological injury [intraventricular hemorrhage grade 3/4 or periventricular leukomalacia], bronchopulmonary dysplasia, retinopathy of prematurity, and necrotizing enterocolitis).Results: Of the 6636 twins, 1934 (29%) were delivered vaginally, 418 (6%) by combined vaginal birth/CS, and 4284 (65%) were born by CS. The composite did not differ between the groups. However, severe neurological injury was decreased (adjusted odds ratio [AOR], 0.77; 95% confidence interval [CI], 0.61-0.98) and respiratory distress syndrome (AOR, 1.34; 95%CI, 1.15-1.56) was increased when both the twins were delivered by CS.Conclusions: Preterm twin infants born via CS experienced less severe neurological injury when compared to those delivered vaginally, but had an increase in respiratory distress syndrome.

• 出版日期2018