title: Adverse perinatal outcomes related to the delivery mode in women with monochorionic diamniotic twin pregnancies.
abstract: OBJECTIVE
  The association between the planned delivery mode and adverse perinatal outcomes of monochorionic diamniotic (MCDA) twin pregnancies at ≥36 weeks' gestation was evaluated.
  
  
  METHODS
  This retrospective cohort study included uncomplicated MCDA twin pregnancies delivered after 36 weeks' gestation during a 10-year period. Cases were classified into the trial of labor (TOL) or cesarean section (CS) group according to the planned delivery mode. The primary outcome was a composite of adverse outcomes for at least one twin, including intrauterine fetal death (IUFD) after 36 weeks, neonatal death, umbilical artery pH<7.1, 5-min Apgar scores<7, hypoxic ischemic encephalopathy (HIE), meconium aspiration syndrome (MAS), respiratory distress syndrome (RDS), or acute feto-fetal hemorrhage (AFFH). The relationship between outcomes and the planned delivery mode was evaluated using a multiple logistic regression analysis.
  
  
  RESULTS
  We included the 310 pregnancies delivered after 36 weeks' gestation. After excluding 15 patients, the final analysis included 295 MCDA pregnancies: 63% had delivered through TOL and 37% through CS. The incidences of composite adverse outcomes in the TOL and CS groups were 4.3% and 1.9%, respectively. No IUFD, neonatal death, MAS, RDS, or AFFH was observed; two infants in each group developed HIE. Adverse outcomes were not significantly associated with any risk factor, including delivery through TOL.
  
  
  CONCLUSIONS
  TOL may not influence the perinatal outcomes of MCDA twin pregnancies delivered at ≥36 weeks' gestation.
authors.forename: Akiko
authors.initials: A
authors.lastname: Yamashita
authors.forename: Keisuke
authors.initials: K
authors.lastname: Ishii
authors.forename: Takako
authors.initials: T
authors.lastname: Taguchi
authors.forename: Aki
authors.initials: A
authors.lastname: Mabuchi
authors.forename: Shiyo
authors.initials: S
authors.lastname: Ota
authors.forename: Jun
authors.initials: J
authors.lastname: Sasahara
authors.forename: Syusaku
authors.initials: S
authors.lastname: Hayashi
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Mitsuda
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D005313:Fetal Death / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D059285:Pregnancy, Twin; D012189:Retrospective Studies; D012307:Risk Factors; D014219:Trial of Labor; D014430:Twins, Monozygotic; D055815:Young Adult