Neonatal outcomes according to actual delivery mode after planned vaginal delivery in women with a twin pregnancy

Simone Mta Goossens; Sabine Ensing; Frans Jme Roumen; Jan G Nijhuis; Ben W Mol

doi:10.1016/j.ejogrb.2020.10.047

Neonatal outcomes according to actual delivery mode after planned vaginal delivery in women with a twin pregnancy

Simone Mta Goossens^* (Corresponding Author), Sabine Ensing, Frans Jme Roumen, Jan G Nijhuis, Ben W Mol

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

Abstract

OBJECTIVE: To compare, in women with twin pregnancy with the first twin in cephalic position, neonatal morbidity and mortality rates after actual 1) Vaginal delivery (VD) both twins versus 2) unplanned Cesarean Delivery (CD) of both twins and 3) after VD of twin A and CD of twin B (combined delivery).

STUDY DESIGN: We describe a nationwide cohort study of women pregnant with twins who planned to deliver vaginally between 32+0 - 41+6 weeks with the first twin in cephalic position, between 2000-2012 in the Netherlands. We used multivariate logistic regression analysis to compare neonatal morbidity and mortality according to actual mode of delivery, overall, and for preterm and term groups separately.

RESULTS: We included 19,723 women of whom 15,785 women (80.0 %) delivered both twins by VD, 2926 (14.6 %) delivered both twins by unplanned CD, and 1012 (5.1 %) women delivered by combined delivery. After unplanned CD of both twins compared to VD more perinatal mortality (1 or more twins affected) was seen (adjusted Odds Ratio (aOR) 2.23 (95 % CI 1.26-4.129)), as was 'Asphyxia related morbidity' (aOR 2.44 (95 % CI 1.80-3.31), 'other morbidity' (aOR 1.34 (95 %CI 1.17-1.54), and 'any morbidity or mortality' (aOR1.39 (95 % CI 1.22-1.58)). Less 'Trauma- related morbidity' after unplanned CD vs. VD (aOR 0.11 (95 % 0.02-0.79)) was seen. After combined delivery vs. VD, more perinatal mortality (aOR 7.75 (95 % CI 4.51-13.34)), more Asphyxia- related morbidity (aOR 6.67 (95 % CI4.91-9.06), 'prematurity related morbidity' (aOR 2.11 (95 % CI 1.59-2.79) 'other morbidity' (aOR 2.01 (95 % CI 1.65-2.46), and 'any morbidity or mortality' (aOR 2.44 (95 % CI 2.04-2.91)) were noted. All outcomes expect 'trauma-associated morbidity' were more increased for twin B as compared to twin A.

CONCLUSION: After unplanned CD of both twins vs. VD of both twins, a twofold increase in neonatal mortality is noted. Combined delivery vs. VD of both twins is associated with a sevenfold increase in perinatal mortality and a five-fold increase in asphyxia-related outcomes. Twin A is more affected after unplanned CD of both twins, while twin B is more affected after combined delivery.

Original language	English
Pages (from-to)	17-24
Number of pages	8
Journal	European Journal of Obstetrics & Gynecology and Reproductive Biology
Volume	256
Early online date	1 Nov 2020
DOIs	https://doi.org/10.1016/j.ejogrb.2020.10.047
Publication status	Published - 1 Jan 2021

Bibliographical note

Declaration of Competing Interest
BWM is supported by a NHMRC Investigatorgrant (GNT1176437), BWM reports consultancy for ObsEva, Merck Merck KGaA, iGenomix and Guerbet
Acknowledgements
We acknowledge Dr. Mark AHBM van der Hoeven † (MD, PhD, Neonatologist Maastricht University Medical Centre +, Department of Neonatology, Maastricht, The Netherlands) for his input in the earlier versions of this manuscript. BWM is supported by a NHMRC Investigator grant (GNT1176437).

Keywords

Twin pregnancy
Delivery method
Caesarean delivery
TRIAL
CESAREAN DELIVERY

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Neonatal outcomes according to actual delivery mode after planned vaginal delivery in women with a twin pregnancy. / Goossens, Simone Mta (Corresponding Author); Ensing, Sabine; Roumen, Frans Jme et al.
In: European Journal of Obstetrics & Gynecology and Reproductive Biology, Vol. 256, 01.01.2021, p. 17-24.

Research output: Contribution to journal › Article › peer-review

@article{98bbdceda4bb4219b5c7742b6030147f,

title = "Neonatal outcomes according to actual delivery mode after planned vaginal delivery in women with a twin pregnancy",

abstract = "OBJECTIVE: To compare, in women with twin pregnancy with the first twin in cephalic position, neonatal morbidity and mortality rates after actual 1) Vaginal delivery (VD) both twins versus 2) unplanned Cesarean Delivery (CD) of both twins and 3) after VD of twin A and CD of twin B (combined delivery).STUDY DESIGN: We describe a nationwide cohort study of women pregnant with twins who planned to deliver vaginally between 32+0 - 41+6 weeks with the first twin in cephalic position, between 2000-2012 in the Netherlands. We used multivariate logistic regression analysis to compare neonatal morbidity and mortality according to actual mode of delivery, overall, and for preterm and term groups separately.RESULTS: We included 19,723 women of whom 15,785 women (80.0 %) delivered both twins by VD, 2926 (14.6 %) delivered both twins by unplanned CD, and 1012 (5.1 %) women delivered by combined delivery. After unplanned CD of both twins compared to VD more perinatal mortality (1 or more twins affected) was seen (adjusted Odds Ratio (aOR) 2.23 (95 % CI 1.26-4.129)), as was 'Asphyxia related morbidity' (aOR 2.44 (95 % CI 1.80-3.31), 'other morbidity' (aOR 1.34 (95 %CI 1.17-1.54), and 'any morbidity or mortality' (aOR1.39 (95 % CI 1.22-1.58)). Less 'Trauma- related morbidity' after unplanned CD vs. VD (aOR 0.11 (95 % 0.02-0.79)) was seen. After combined delivery vs. VD, more perinatal mortality (aOR 7.75 (95 % CI 4.51-13.34)), more Asphyxia- related morbidity (aOR 6.67 (95 % CI4.91-9.06), 'prematurity related morbidity' (aOR 2.11 (95 % CI 1.59-2.79) 'other morbidity' (aOR 2.01 (95 % CI 1.65-2.46), and 'any morbidity or mortality' (aOR 2.44 (95 % CI 2.04-2.91)) were noted. All outcomes expect 'trauma-associated morbidity' were more increased for twin B as compared to twin A.CONCLUSION: After unplanned CD of both twins vs. VD of both twins, a twofold increase in neonatal mortality is noted. Combined delivery vs. VD of both twins is associated with a sevenfold increase in perinatal mortality and a five-fold increase in asphyxia-related outcomes. Twin A is more affected after unplanned CD of both twins, while twin B is more affected after combined delivery.",

keywords = "Twin pregnancy, Delivery method, Caesarean delivery, TRIAL, CESAREAN DELIVERY",

author = "Goossens, {Simone Mta} and Sabine Ensing and Roumen, {Frans Jme} and Nijhuis, {Jan G} and Mol, {Ben W}",

note = "Declaration of Competing Interest BWM is supported by a NHMRC Investigatorgrant (GNT1176437), BWM reports consultancy for ObsEva, Merck Merck KGaA, iGenomix and Guerbet Acknowledgements We acknowledge Dr. Mark AHBM van der Hoeven † (MD, PhD, Neonatologist Maastricht University Medical Centre +, Department of Neonatology, Maastricht, The Netherlands) for his input in the earlier versions of this manuscript. BWM is supported by a NHMRC Investigator grant (GNT1176437).",

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doi = "10.1016/j.ejogrb.2020.10.047",

language = "English",

volume = "256",

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journal = "European Journal of Obstetrics & Gynecology and Reproductive Biology",

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TY - JOUR

T1 - Neonatal outcomes according to actual delivery mode after planned vaginal delivery in women with a twin pregnancy

AU - Goossens, Simone Mta

AU - Ensing, Sabine

AU - Roumen, Frans Jme

AU - Nijhuis, Jan G

AU - Mol, Ben W

N1 - Declaration of Competing Interest BWM is supported by a NHMRC Investigatorgrant (GNT1176437), BWM reports consultancy for ObsEva, Merck Merck KGaA, iGenomix and Guerbet Acknowledgements We acknowledge Dr. Mark AHBM van der Hoeven † (MD, PhD, Neonatologist Maastricht University Medical Centre +, Department of Neonatology, Maastricht, The Netherlands) for his input in the earlier versions of this manuscript. BWM is supported by a NHMRC Investigator grant (GNT1176437).

PY - 2021/1/1

Y1 - 2021/1/1

N2 - OBJECTIVE: To compare, in women with twin pregnancy with the first twin in cephalic position, neonatal morbidity and mortality rates after actual 1) Vaginal delivery (VD) both twins versus 2) unplanned Cesarean Delivery (CD) of both twins and 3) after VD of twin A and CD of twin B (combined delivery).STUDY DESIGN: We describe a nationwide cohort study of women pregnant with twins who planned to deliver vaginally between 32+0 - 41+6 weeks with the first twin in cephalic position, between 2000-2012 in the Netherlands. We used multivariate logistic regression analysis to compare neonatal morbidity and mortality according to actual mode of delivery, overall, and for preterm and term groups separately.RESULTS: We included 19,723 women of whom 15,785 women (80.0 %) delivered both twins by VD, 2926 (14.6 %) delivered both twins by unplanned CD, and 1012 (5.1 %) women delivered by combined delivery. After unplanned CD of both twins compared to VD more perinatal mortality (1 or more twins affected) was seen (adjusted Odds Ratio (aOR) 2.23 (95 % CI 1.26-4.129)), as was 'Asphyxia related morbidity' (aOR 2.44 (95 % CI 1.80-3.31), 'other morbidity' (aOR 1.34 (95 %CI 1.17-1.54), and 'any morbidity or mortality' (aOR1.39 (95 % CI 1.22-1.58)). Less 'Trauma- related morbidity' after unplanned CD vs. VD (aOR 0.11 (95 % 0.02-0.79)) was seen. After combined delivery vs. VD, more perinatal mortality (aOR 7.75 (95 % CI 4.51-13.34)), more Asphyxia- related morbidity (aOR 6.67 (95 % CI4.91-9.06), 'prematurity related morbidity' (aOR 2.11 (95 % CI 1.59-2.79) 'other morbidity' (aOR 2.01 (95 % CI 1.65-2.46), and 'any morbidity or mortality' (aOR 2.44 (95 % CI 2.04-2.91)) were noted. All outcomes expect 'trauma-associated morbidity' were more increased for twin B as compared to twin A.CONCLUSION: After unplanned CD of both twins vs. VD of both twins, a twofold increase in neonatal mortality is noted. Combined delivery vs. VD of both twins is associated with a sevenfold increase in perinatal mortality and a five-fold increase in asphyxia-related outcomes. Twin A is more affected after unplanned CD of both twins, while twin B is more affected after combined delivery.

AB - OBJECTIVE: To compare, in women with twin pregnancy with the first twin in cephalic position, neonatal morbidity and mortality rates after actual 1) Vaginal delivery (VD) both twins versus 2) unplanned Cesarean Delivery (CD) of both twins and 3) after VD of twin A and CD of twin B (combined delivery).STUDY DESIGN: We describe a nationwide cohort study of women pregnant with twins who planned to deliver vaginally between 32+0 - 41+6 weeks with the first twin in cephalic position, between 2000-2012 in the Netherlands. We used multivariate logistic regression analysis to compare neonatal morbidity and mortality according to actual mode of delivery, overall, and for preterm and term groups separately.RESULTS: We included 19,723 women of whom 15,785 women (80.0 %) delivered both twins by VD, 2926 (14.6 %) delivered both twins by unplanned CD, and 1012 (5.1 %) women delivered by combined delivery. After unplanned CD of both twins compared to VD more perinatal mortality (1 or more twins affected) was seen (adjusted Odds Ratio (aOR) 2.23 (95 % CI 1.26-4.129)), as was 'Asphyxia related morbidity' (aOR 2.44 (95 % CI 1.80-3.31), 'other morbidity' (aOR 1.34 (95 %CI 1.17-1.54), and 'any morbidity or mortality' (aOR1.39 (95 % CI 1.22-1.58)). Less 'Trauma- related morbidity' after unplanned CD vs. VD (aOR 0.11 (95 % 0.02-0.79)) was seen. After combined delivery vs. VD, more perinatal mortality (aOR 7.75 (95 % CI 4.51-13.34)), more Asphyxia- related morbidity (aOR 6.67 (95 % CI4.91-9.06), 'prematurity related morbidity' (aOR 2.11 (95 % CI 1.59-2.79) 'other morbidity' (aOR 2.01 (95 % CI 1.65-2.46), and 'any morbidity or mortality' (aOR 2.44 (95 % CI 2.04-2.91)) were noted. All outcomes expect 'trauma-associated morbidity' were more increased for twin B as compared to twin A.CONCLUSION: After unplanned CD of both twins vs. VD of both twins, a twofold increase in neonatal mortality is noted. Combined delivery vs. VD of both twins is associated with a sevenfold increase in perinatal mortality and a five-fold increase in asphyxia-related outcomes. Twin A is more affected after unplanned CD of both twins, while twin B is more affected after combined delivery.

KW - Twin pregnancy

KW - Delivery method

KW - Caesarean delivery

KW - TRIAL

KW - CESAREAN DELIVERY

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U2 - 10.1016/j.ejogrb.2020.10.047

DO - 10.1016/j.ejogrb.2020.10.047

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C2 - 33161210

SN - 0301-2115

VL - 256

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JO - European Journal of Obstetrics & Gynecology and Reproductive Biology

JF - European Journal of Obstetrics & Gynecology and Reproductive Biology

ER -

Neonatal outcomes according to actual delivery mode after planned vaginal delivery in women with a twin pregnancy

Abstract

Bibliographical note

Keywords

UN SDGs

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