Neonatal outcome of very preterm twins: policy of planned vaginal or cesarean delivery

Am J Obstet Gynecol. 2015 Jul;213(1):73.e1-73.e7. doi: 10.1016/j.ajog.2015.02.020. Epub 2015 Feb 25.


Objective: The objective of the study was to compare neonatal mortality and morbidity in very preterm twins with the first twin in cephalic presentation in hospitals with a policy of planned vaginal delivery (PVD) and those with a policy of planned cesarean delivery (PCD).

Study design: Women with preterm cephalic first twins delivered after preterm labor and/or premature preterm rupture of membranes from 26(0/7) to 31(6/7) weeks of gestation were identified from the databases of 6 perinatal centers and classified as PVD or PCD according to the center's management policy from 1999 to 2010. Severe neonatal morbidity was defined as any of the following: intraventricular hemorrhage grades 3-4, periventricular leukomalacia, necrotizing enterocolitis, bronchopulmonary dysplasia, and hospital death. The independent effect of the planned mode of delivery, defined by the center's management policy, was tested and quantified with a 2-level multivariable logistic regression.

Results: The PVD group included 248 women, and the PCD group 63. Maternal characteristics did not differ between the 2 groups. The rate of vaginal delivery was 85.9% (213 of 248) vs 20.6% (13 of 63) (P < .001), and the rate of cesarean delivery for the second twin was 1.6% (4 of 248) vs 4.8% (3 of 63) (P = .13) for PVD and PCD. PVD had no independent effect on either newborn hospital mortality or severe neonatal composite morbidity.

Conclusion: A policy of planned vaginal delivery of very preterm twins with the first twin in cephalic presentation does not increase either severe neonatal morbidity or mortality.

Keywords: cesarean delivery; neonatal death; neonatal morbidity; preterm birth; twins.

MeSH terms

  • Adult
  • Bronchopulmonary Dysplasia / epidemiology
  • Cerebral Hemorrhage / epidemiology
  • Cesarean Section
  • Delivery, Obstetric*
  • Enterocolitis, Necrotizing / epidemiology
  • Female
  • France
  • Hospital Mortality
  • Humans
  • Infant, Extremely Premature
  • Infant, Premature*
  • Leukomalacia, Periventricular / epidemiology
  • Models, Statistical
  • Pregnancy
  • Pregnancy Outcome*
  • Retrospective Studies
  • Twins*