Neonatal and maternal outcomes in twin gestations > or =32 weeks according to the planned mode of delivery.
OBJECTIVE
To determine a possible relationship between neonatal and maternal outcomes in twin gestations and the planned mode of delivery.


METHODS
A single-centre retrospective cohort study in twins > or =32 weeks of gestational age was performed. Baseline characteristics, and neonatal and maternal outcomes were documented according to the planned mode of delivery: a planned caesarean section or a planned vaginal birth. Statistical analysis was performed using chi-square test. Fisher exact test was used in case correction was needed.


RESULTS
During the study period (1999-2002), 164 twins > or =32 weeks were enrolled in the study. In 29 women (17.7%) an elective caesarean section was performed. The remaining 135 twins (82.3%) were allowed to start a vaginal delivery. An emergency or an urgent secondary caesarean section for both twins was performed in 26 women, and in 2 women for twin B only. One twin B baby died during planned vaginal delivery. No significant differences in perinatal mortality and serious neonatal morbidity were found between both groups (10.3% versus 9.6%). Neonatal outcomes in twins A were significantly better than in twins B (2.4% versus 7.3%), independent of the planned mode of delivery. Serious maternal morbidity was not significantly different between both groups (13.8% versus 19.3%), although 2 women in the elective caesarean section group needed a relaparotomy for haemorrhage.


CONCLUSIONS
Our results do not support an elective caesarean section for twin gestations > or =32 weeks. The success rate of vaginal delivery in the planned vaginal birth group was nearly 80%.
Haest
Kim M J
KM
Atrium Medical Centre Heerlen, The Netherlands. zipphaest@nutsonline.nl
Roumen
Frans J M E
FJ
Nijhuis
Jan G
JG
D000328:Adult; D002585:Cesarean Section / Q000523:psychology / Q000639:trends; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D009017:Morbidity; D011247:Pregnancy; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014427:Twins