The impact of mode of delivery on the outcome in very preterm twins

Objective: Studies on the optimal mode of delivery in women with a twin pregnancy <32 weeks are scarce. We studied the effects of the mode of delivery on perinatal and maternal outcomes in very preterm twin pregnancy. Study Design: Population-based cohort study including all women with twin pregnancy who delivered very preterm (26–32 weeks of gestation) in the Netherlands between January 2000 and December 2010. We compared perinatal mortality and neonatal and maternal morbidity according to the intended mode of delivery as well as to the actual mode of delivery. Perinatal outcomes were paired taking into account the dependency between the children of the same twin pregnancy and were also analysed for each child separately. We used logistic regression to correct for possible confounding factors. Results: We studied 1,655 women with a very preterm delivery of a twin pregnancy. A planned caesarean section (n = 212) was associated with a significantly higher perinatal mortality compared to a planned vaginal delivery (n = 1.443) (10% compared to 6.5%; adjusted odds ratio (OR) 2.5, 95% confidence interval (CI) 1.5–4.2). The same applied for perinatal morbidity (66% compared to 63%; adjusted OR 1.5, 95% CI 1.1–2.0), maternal morbidity (17% compared to 4.9%; adjusted OR 4.0, 95% CI 2.6–6.3) and for perinatal mortality for the second twin (7.1% compared to 3.5% adjusted OR 2.9, 95% CI 1.7–5.2). Conclusion: In very preterm delivery of twins a vaginal delivery is the preferred mode of delivery.