medigraphic.com
Federación Mexicana de Ginecología y Obstetricia, A.C.

2020, Number 11

Ginecol Obstet Mex 2020; 88 (11)

Maternofetal outcomes comparing vaginal delivery and planned caesarean section in twin pregnancies

Vázquez-Maiz O, Ginto-Zabaleta LM, Zubikarai-Iturralde M, Aristegui-Guridi O, Navarrina-Martínez JÁ, Lekuona-Artola A

Language: Spanish
References: 19
Page: 735-744
PDF size: 211.45 Kb.


ABSTRACT

Objective: To compare maternal and neonatal morbidity and mortality between trial of labor and planned caesarean section in twin pregnancies.
Materials and Methods: A retrospective cohort study in Donostia University Hospital during 2016 and 2017 including monochorial-biamniotic and bichorial biamniotic twin pregnancies ›24+0 weeks of gestation. Gestations with antenatal death of one or both fetuses were excluded. Patients were classified into trial of labor group and planned cesarean section group. Primary outcomes were maternal and neonatal morbidity and mortality. Statistical analysis included χ2, Fisher´s exact test, Student´s T-test, Mann-Whitney U test and binary logistic regression models.
Results: Of 248 twin births, 173 (69.8%) were included in the attempted delivery group and 75 (30.2%) in the scheduled cesarean section group. No difference was found in maternal morbidity and mortality (OR 0.92; 95% CI 0.36-2.36). The attempted group had lower rates of admission to neonatal intensive care (first twin OR 0.27; 95% CI 0.13-0.56; second twin OR 0.29; 95% CI 0.14-0.58) and lower neonatal morbidity (first twin OR 0.37; 95% CI 0.19-0.71; second twin OR 0.42; 95% CI 0.22-0.79). The pH of the second twin’s cord blood was lower in the attempted delivery group (7.24 vs 7.28; p 0.017).
Conclusions: Although second twins’ umbilical artery pH is lower in trial of labor group, neonatal morbidity is decreased. Therefore, trial of labor in selected cases is an adequate option that does not increase maternal and neonatal morbidity and mortality.


REFERENCES

  1. Euro-Peristat Project. European Perinatal Health Report. Core indicators of the health and care of pregnant women and babies in Europe in 2015. https://www.europeristat.com/index. php/reports/european-perinatal-health-report-2015.html.

  2. Hernández HR, et al. Prevalencia de embarazos múltiples: incremento en la última década. Ginecol Obstet Mex 2008; 76 (9): 507-11.

  3. Multiple pregnancy: antenatal care for twin and triplet pregnancies. Clinical guideline CG129. https://www.nice. org.uk/guidance/CG129/.

  4. Chasen S, Chervenak F. Twin pregnancy: Labour and delivery. http://www.Uptodate.com.

  5. Armson BA, et al. Determinants of perinatal mortality and serious neonatal morbidity in the second twin. Obstet Gynecol 2006; 108 (3): 556-64. https://doi.org/10.1097/01. AOG.0000227747.37184.0a

  6. Smith GC, et al. Mode of delivery and the risk of deliveryrelated perinatal death among twins at term: a retrospective cohort study of 8073 births. BJOG 2005; 112: 1139-44. https://doi.org/10.1111/j.1471-0528.2005.00631.x

  7. Smith GC, et al. Birth order of twins and risk of perinatal death related to delivery in England, Northern Ireland, and Wales, 1994–2003: retrospective cohort study. BMJ 2007; 334: 576-78. https://doi.org/10.1136/bmj.39118.483819.55

  8. Hogle KL, et al. Cesarean delivery for twins: a systematic review and meta-analysis. Am J Obstet Gynecol 2003; 188: 220-7. https://doi.org/10.1067/mob.2003.64

  9. Rossi AC, et al. Neonatal outcomes of twins according to birth order, presentation and mode of delivery: a systematic review and meta-analysis. BJOG 2011; 118: 523-32. https://doi.org/10.1111/j.1471-0528.2010.02836.x

  10. Quesnel García-Benítez C, et al. Parto gemelar ¿es una opción segura? Ginecol Obstet Mex 2011; 79 (10): 621-30.

  11. Barrett JF, et al. A randomized trial of planned cesarean or vaginal delivery for twin pregnancy. N Engl J Med 2013; 369: 1295-305. https://doi.org/10.1056/NEJMoa1214939

  12. Malin GL, et al. Strength of association between umbilical cord pH and perinatal and long-term outcomes: systematic review and meta-analysis. BMJ 2010; 340: c1471. https:// doi.org/10.1136/bmj.c1471

  13. Ylilehto E, et al. Term twin birth: impact of mode of delivery on outcome. AOGS 2017; 96 (5): 589-96. https://doi. org/10.1111/aogs.13122

  14. Hogan L, et al. How often is a low five-minute Apgar score in term newborns due to asphyxia? EJOG 2007; 130: 169-75. https://doi.org/10.1016/j.ejogrb.2006.03.002

  15. Souza JP, et al. Caesarean section without medical indications is associated with an increased risk of adverse short term maternal outcomes: The 2004-2008 WHO Global Survey on Maternal and Perinatal Health. BMC Med 2010; 8: 71. https://doi.org/10.1186/1741-7015-8-71

  16. Berghella V, Lockwood CJ. Cesarean delivery: Postoperative issues. http://www.Uptodate.com.

  17. Armson BA. Is planned cesarean childbirth a safe alternative? CMAJ 2007; 176 (4): 475-76. https://doi.org/10.1503/ cmaj.061724

  18. Declercq E, et al. Maternal outcomes associated with planned primary cesarean births compared with planned vaginal births. Obstet Gynecol 2007; 109 (3): 669-77. https://doi.org/10.1097/01.AOG.0000255668.20639.40

  19. Liu S, et al. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ 2007; 176 (4): 455-60. https://doi.org/10.1503/cmaj.060870




2020     |     www.medigraphic.com