title: Optimizing outcome of twins by routine cesarean section beyond 37 weeks.
abstract: The appropriate time and the optimal mode of delivery of twins are still controversial. We assessed the effect of gestational age and the mode of elective delivery of twins on the occurrence of neonatal respiratory morbidity (NRM) and of maternal morbidity. This study included twins born beyond 35 weeks' gestation. NRM was defined as respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN). Additionally, maternal complications related to the different modes of delivery were taken into account. Of 711 twin pregnancies (1422 liveborn neonates) included, 74 (5.2%) experienced NRM. Maternal age > 25 years, delivery at an earlier gestational age, and delivery by emergency cesarean section maintained statistical significance with NRM. From the maternal point of view, increased length of hospitalization ( P = 0.045) and the need for postoperative antibiotics ( P = 0.0065) were significantly higher following an emergency cesarean section than after an elective cesarean birth. The risk of NRM in twins born beyond 37 weeks' gestation is rather low. We suggest considering elective cesarean delivery at completion of 37 weeks. This can be performed safely in regard to NRM, the trade-off being reduced maternal morbidity associated with elective cesarean delivery.
authors.affiliation: Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel. y_zipori@rambam.health.gov.il
authors.forename: Yaniv
authors.initials: Y
authors.lastname: Zipori
authors.forename: Tatiana
authors.initials: T
authors.lastname: Smolkin
authors.forename: Imad R
authors.initials: IR
authors.lastname: Makhoul
authors.forename: Amir
authors.initials: A
authors.lastname: Weissman
authors.forename: Shraga
authors.initials: S
authors.lastname: Blazer
authors.forename: Arie
authors.initials: A
authors.lastname: Drugan
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D016009:Chi-Square Distribution; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D004638:Emergency Treatment / Q000009:adverse effects; D005260:Female; D005334:Fever / Q000209:etiology; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay; D016015:Logistic Models; D008423:Maternal Age; D009017:Morbidity; D011247:Pregnancy; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology* / Q000209:etiology; D056152:Respiratory Rate; D012189:Retrospective Studies; D012307:Risk Factors; D014427:Twins