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Neonatal Outcomes of Twin Pregnancy According to the Planned Mode of Delivery

From the ¹Maternité Port-Royal, Hôpital Cochin, AP-HP; ²Université Paris Descartes; ³Service de Médecine Néonatale de Port-Royal, Hôpital Cochin, AP-HP; and ⁴INSERM U149, Hôpital Saint-Vincent-de-Paul, Paris, France.

OBJECTIVES: To assess neonatal morbidity in twin pregnancy according to the planned mode of delivery.

METHODS: A retrospective cohort study of 758 consecutive sets of twins born after 35 weeks of gestation with a cephalic-presenting first twin was undertaken in a level III maternity unit in which active management of the second twin delivery is performed routinely. The primary outcome was a composite measure of neonatal mortality and morbidity, including pH less than 7.0, 5-minute Apgar score less than 4, neonatal intensive care unit transfer more than 4 days, pneumothorax, and fracture. Control for potential confounders was performed by excluding from the analysis women who experienced pregnancy complications and by using logistic regression models.

RESULTS: Vaginal or cesarean delivery was planned for 657 (86.7%) and 101 (13.3%) women, respectively. Among planned vaginal deliveries, 515 (78.4%) patients delivered both twins vaginally, 139 (21.1%) had a cesarean delivery during labor, and 3 (0.5%) had cesarean delivery for the second twin. After vaginal birth of the first twin, the mean intertwin delivery interval was 4.9±3.2 minutes. When patients who experienced pregnancy complications were excluded (n=202), the neonatal composite morbidity for the second twin did not differ between planned cesarean and planned vaginal delivery (5.0% compared with 4.7%, adjusted odds ratio 1.5, 95% confidence interval 0.3–7.4, P=.63). Neonatal composite morbidity of first twins did not differ between groups.

CONCLUSION: For twin gestations with a cephalic-presenting first twin, planned vaginal delivery after 35 weeks of gestation in selected women remains a safe option in centers used to active management of the second twin delivery.

LEVEL OF EVIDENCE: II