title: Indicated and non-indicated preterm delivery in twin gestations: impact on neonatal outcome and cost.
abstract: OBJECTIVE
  To identify the etiology and impact of preterm delivery in twin gestations.
  
  
  METHODS
  Twin gestations delivered at 33.0 to 36.9 weeks were identified in a perinatal database, and categorized by indication for delivery. Deliveries were identified as indicated, or non-indicated (discretionary). Neonatal outcomes were measured by birth weight, length of stay, NICU admission, and ventilator utilization. Data were divided and analyzed by indicated or discretionary delivery, and gestational age at delivery.
  
  
  RESULTS
  Analyzed were 3252 twin gestations (6504 infants), with 78% having indicated delivery. Of the 22% with discretionary delivery, nearly 40% required NICU admission. With each advancing week of gestation, there was a significant decrease in incidence of NICU admission and nursery days.
  
  
  CONCLUSIONS
  The majority of preterm deliveries were indicated, though 22% were discretionary. It is vital to consider neonatal morbidity and costs related to gestational age when choosing discretionary delivery.
authors.affiliation: Department of Maternal-FetalMedicine, Good Samaritan Medical Center, Phoenix, AZ 85006, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Elliott
authors.forename: Niki B
authors.initials: NB
authors.lastname: Istwan
authors.forename: Ann
authors.initials: A
authors.lastname: Collins
authors.forename: Debbie
authors.initials: D
authors.lastname: Rhea
authors.forename: Gary
authors.initials: G
authors.lastname: Stanziano
mesh_terms: D000328:Adult; D001724:Birth Weight; D002585:Cesarean Section; D017281:Cost of Illness; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007902:Length of Stay; D011247:Pregnancy; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple; D047928:Premature Birth / Q000191:economics* / Q000209:etiology*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D014427:Twins