title: Neonatal outcomes of twin pregnancy according to the planned mode of delivery.
abstract: OBJECTIVE
  To assess neonatal morbidity in twin pregnancy according to the planned mode of delivery.
  
  
  METHODS
  A retrospective cohort study of 758 consecutive sets of twins born after 35 weeks of gestation with a cephalic-presenting first twin was undertaken in a level III maternity unit in which active management of the second twin delivery is performed routinely. The primary outcome was a composite measure of neonatal mortality and morbidity, including pH less than 7.0, 5-minute Apgar score less than 4, neonatal intensive care unit transfer more than 4 days, pneumothorax, and fracture. Control for potential confounders was performed by excluding from the analysis women who experienced pregnancy complications and by using logistic regression models.
  
  
  RESULTS
  Vaginal or cesarean delivery was planned for 657 (86.7%) and 101 (13.3%) women, respectively. Among planned vaginal deliveries, 515 (78.4%) patients delivered both twins vaginally, 139 (21.1%) had a cesarean delivery during labor, and 3 (0.5%) had cesarean delivery for the second twin. After vaginal birth of the first twin, the mean intertwin delivery interval was 4.9+/-3.2 minutes. When patients who experienced pregnancy complications were excluded (n=202), the neonatal composite morbidity for the second twin did not differ between planned cesarean and planned vaginal delivery (5.0% compared with 4.7%, adjusted odds ratio 1.5, 95% confidence interval 0.3-7.4, P=.63). Neonatal composite morbidity of first twins did not differ between groups.
  
  
  CONCLUSIONS
  For twin gestations with a cephalic-presenting first twin, planned vaginal delivery after 35 weeks of gestation in selected women remains a safe option in centers used to active management of the second twin delivery.
authors.affiliation: Maternité Port-Royal, Hôpital Cochin, AP-HP, Paris, France. thomas.schmitz@cch.aphp.fr
authors.forename: Thomas
authors.initials: T
authors.lastname: Schmitz
authors.forename: Céline de Carné
authors.initials: Cde C
authors.lastname: Carnavalet
authors.forename: Elie
authors.initials: E
authors.lastname: Azria
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Lopez
authors.forename: Dominique
authors.initials: D
authors.lastname: Cabrol
authors.forename: François
authors.initials: F
authors.lastname: Goffinet
mesh_terms: D000328:Adult; D001034:Apgar Score; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D005865:Gestational Age; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology*; D007746:Labor Presentation; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000503:physiopathology; D016017:Odds Ratio; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D014427:Twins