title: Impact of mode of delivery after 32 weeks' gestation on neonatal outcome in dichorionic diamniotic twins.
abstract: OBJECTIVE
  The purpose of this study was to investigate neonatal outcome of dichorionic diamniotic twins born beyond 32 weeks' gestation according to mode of delivery at a major tertiary center in Australia.
  
  
  METHODS
  This was a retrospective cohort study of women with dichorionic diamniotic twins delivering at ≥32 weeks' gestation at a large tertiary maternity center in Australia using data from a maternity database. Primary and secondary outcomes included mode of delivery, birthweight, stillbirth, Apgar score, neonatal unit admission, neonatal resuscitation, death and respiratory distress.
  
  
  RESULTS
  Of 1261 women, 82.9% (1045/1261; 2090 babies) delivered at ≥32 weeks' gestation. The mode of delivery for these babies was as follows: normal vaginal delivery, 419 (20%); instrumental delivery, 179 (8.6%); emergency cesarean section, 658 (31.5%); and elective cesarean section, 834 (39.9%). Babies delivered by emergency cesarean section or instrumental vaginal delivery had worse outcome. In contrast, the lowest complications were seen in the uncomplicated vaginal delivery and elective cesarean section cohorts.
  
  
  CONCLUSIONS
  Neonatal outcome was worse for those delivering via emergency cesarean section or instrumental vaginal delivery compared with elective cesarean section or uncomplicated vaginal delivery. The rate of uncomplicated vaginal delivery, however, was low, with only 14.8% of women delivering both babies vaginally without any form of intervention.
authors.affiliation: Mater Mothers' Hospital, South Brisbane, Queensland, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Soong
authors.affiliation: Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia.
authors.forename: Ristan M
authors.initials: RM
authors.lastname: Greer
authors.affiliation: Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia.|Mater Mothers' Hospital, South Brisbane, Queensland, Australia.
authors.forename: Glenn
authors.initials: G
authors.lastname: Gardener
authors.affiliation: Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia.
authors.forename: Vicki
authors.initials: V
authors.lastname: Flenady
authors.affiliation: Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia.|Mater Mothers' Hospital, South Brisbane, Queensland, Australia.
authors.forename: Sailesh
authors.initials: S
authors.lastname: Kumar
mesh_terms: D000328:Adult; D001315:Australia; D002585:Cesarean Section; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods*; D005321:Extraembryonic Membranes; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D059285:Pregnancy, Twin; D012189:Retrospective Studies; D014427:Twins
keywords: cesarean section; neonatal morbidity; neonatal outcome; twins; vaginal delivery