Comparison of planned caesarean delivery and planned vaginal delivery in women with a twin pregnancy: A nation wide cohort study

Objective To compare, in women with twin pregnancy with the first twin in cephalic position, neonatal morbidity and mortality rates after planned Ceasarean delivery (CD) versus planned vaginal delivery (VD). Study Design A nationwide cohort study on women pregnant with twins and the first child in cephalic position, who delivered between 32 + 0–41 + 0 weeks between 2000 and 2012 in the Netherlands, using multivariate logistic regression analysis to compare neonatal morbidity and mortality according to planned delivery mode, and looked at subgroups 32 + 0–36 + 6 and 37 + 0–41 + 0 weeks. Results We included 21,107 women, of whom 1384 (6.6%) had a planned CD. Of the 19,723 women (93.4%) who had a planned VD, 19.7% delivered by intrapartum CD. We found no significant differences in ‘any mortality’ (aOR planned CD vs. planned VD 1.34 (95% CI 0.63–2.60)), the outcome ‘Apgar score (AS) < 4 or death within 28 days’ (aOR 1.28 (95% CI 0.77–2.11) or asphyxia-related morbidity (aOR 0.57 (95% CI 0.32–1.03)). After planned CD more prematurity-related morbidity (aOR 1.55 (95% CI 1.21–1.98)) other morbidity (aOR 1.50 (95% CI 1.26–1.78)) and ‘any morbidity or mortality’ (aOR 1.41 (95% CI 1.20–1.66) was noted. Trauma-associated morbidity was absent after planned CD and occurred 45 times (0.2%) after planned VD. Before 36 + 6 weeks, planned CD resulted in more perinatal mortality (aOR 2.10 (95% CI 0.92–4.76)), while asphyxia-related morbidity did not differ (aOR0.80 (95% CI 0.41–1.54). Planned CD resulted in more ‘any morbidity or mortality’ (aOR 1.52 (95% CI 1.25–1.84)), ‘AS < 4 or death within 28 days’ (aOR 1.77 (95% CI 1.02–3.09)), prematurity-related morbidity (aOR 1.73 (95% CI 1.34–2.23)), and ‘other morbidity’ (aOR 1.56 (95% CI 1.28–1.90)). After 37 weeks, no significance differences in mortality, ‘any morbidity or mortality <28 days’ (aOR 0.96 (95% CI 1 (0.67–1.38)), or ‘AS < 4 or death within 28 days’ (aOR 0.41 (95% CI (0.10–1.70)) were found. There was less asphyxia-related morbidity after planned CD (aOR 0.24 (95% CI 0.06–1.002)). Conclusion Planned VD results in comparable neonatal outcomes as planned CD for twin pregnancy with the first twin in cephalic position, even with a low intrapartum CD rate of 19.7%. At term, a planned CD may result in less asphyxia- and trauma-related outcomes.