Neonatal outcome of very preterm twins: policy of planned vaginal or cesarean delivery.
OBJECTIVE
The objective of the study was to compare neonatal mortality and morbidity in very preterm twins with the first twin in cephalic presentation in hospitals with a policy of planned vaginal delivery (PVD) and those with a policy of planned cesarean delivery (PCD).


METHODS
Women with preterm cephalic first twins delivered after preterm labor and/or premature preterm rupture of membranes from 26(0/7) to 31(6/7) weeks of gestation were identified from the databases of 6 perinatal centers and classified as PVD or PCD according to the center's management policy from 1999 to 2010. Severe neonatal morbidity was defined as any of the following: intraventricular hemorrhage grades 3-4, periventricular leukomalacia, necrotizing enterocolitis, bronchopulmonary dysplasia, and hospital death. The independent effect of the planned mode of delivery, defined by the center's management policy, was tested and quantified with a 2-level multivariable logistic regression.


RESULTS
The PVD group included 248 women, and the PCD group 63. Maternal characteristics did not differ between the 2 groups. The rate of vaginal delivery was 85.9% (213 of 248) vs 20.6% (13 of 63) (P < .001), and the rate of cesarean delivery for the second twin was 1.6% (4 of 248) vs 4.8% (3 of 63) (P = .13) for PVD and PCD. PVD had no independent effect on either newborn hospital mortality or severe neonatal composite morbidity.


CONCLUSIONS
A policy of planned vaginal delivery of very preterm twins with the first twin in cephalic presentation does not increase either severe neonatal morbidity or mortality.
Department of Obstetrics and Gynecology, Angers University Hospital, Angers, France. Electronic address: loicsentilhes@hotmail.com.
Loïc
L
Sentilhes
Department of Obstetrics and Gynecology, Départment Hospitalo Universitaire "Risks and Pregnancy" Louis Mourier Hospital, Assistance Publique-Hôpitaux de Paris, University Paris-Diderot, Colombes, France.
Anne
A
Oppenheimer
Department of Obstetrics and Gynecology, Angers University Hospital, Angers, France.
Anne-Charlotte
AC
Bouhours
Department of Obstetrics and Gynecology, Départment Hospitalo Universitaire "Risks and Pregnancy" Louis Mourier Hospital, Assistance Publique-Hôpitaux de Paris, University Paris-Diderot, Colombes, France.
Estelle
E
Normand
Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal de Créteil, Assistance Publique-Hôpitaux de Paris, Créteil, France.
Bassam
B
Haddad
Department of Obstetrics and Gynecology, Angers University Hospital, Angers, France.
Philippe
P
Descamps
Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France.
Loïc
L
Marpeau
Department of Obstetrics and Gynecology, Maternity Port-Royal Hospital, Cochin Assistance Publique-Hôpitaux de Paris, University René Descartes, Paris, France.
François
F
Goffinet
Department of Obstetrics and Gynecology, Départment Hospitalo Universitaire "Risks and Pregnancy" Louis Mourier Hospital, Assistance Publique-Hôpitaux de Paris, University Paris-Diderot, Colombes, France.
Gilles
G
Kayem
D000328:Adult; D001997:Bronchopulmonary Dysplasia / Q000453:epidemiology; D002543:Cerebral Hemorrhage / Q000453:epidemiology; D002585:Cesarean Section; D036861:Delivery, Obstetric; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology; D005260:Female; D005602:France; D017052:Hospital Mortality; D006801:Humans; D062071:Infant, Extremely Premature; D007234:Infant, Premature; D007969:Leukomalacia, Periventricular / Q000453:epidemiology; D015233:Models, Statistical; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D014427:Twins
cesarean delivery; neonatal death; neonatal morbidity; preterm birth; twins