Twin births: cesarean section or vaginal delivery?

Elise Hoffmann; Anna Oldenburg; Line Rode; Ann Tabor; Steen Rasmussen; Lillian Skibsted

doi:10.1111/j.1600-0412.2011.01356.x

Twin births: cesarean section or vaginal delivery?

Elise Hoffmann, Anna Oldenburg, Line Rode, Ann Tabor, Steen Rasmussen, Lillian Skibsted

47 Citations (Scopus)

Abstract

Objective. To assess morbidity and mortality in twin pregnancy deliveries, according to chorionicity and mode of delivery. Design. Population-based retrospective cohort. Setting. Fourteen obstetric departments in Denmark. Population. One thousand one hundred and seventy-five twin pregnancies with two live fetuses at 36 ⁺⁰ weeks of gestation. Methods. Pregnancy outcomes assessed according to chorionicity and mode of delivery. Main outcome measures. Poor outcome defined as five min Apgar score ≤ 7, umbilical artery pH < 7.10, admission to neonatal unit for more than three days or death. Results. Dichorionic (DC) twins, delivered after 36 gestational weeks, with intended vaginal delivery (n= 689) compared with DC twins with planned cesarean section (n= 371) had an increased risk of poor outcome [odds ratio (OR) 1.47, p= 0.037] after adjustment for body mass index, parity and weight discordance. There was no increased risk for poor outcome in monochorionic (MC) twins with intended vaginal delivery (n= 63) compared with planned cesarean section (n= 52; OR 0.87, 95% confidence interval 0.26-2.96). Nulliparity increased the risk of poor outcome in DC (OR 1.5, p= 0.03) and in MC twins (OR 4.01, p= 0.02), as well as birthweight discordance >300 g (DC, OR 1.50, p= 0.02; and MC, OR 6.02, p= 0.002). For DC twins, we found a significantly higher risk of poor outcome of the second-born twin compared with the first (OR 1.64, p= 0.001). Conclusions. Dichorionic twins born after 36 weeks of gestation had a higher risk of poor outcome by intended vaginal delivery than by planned cesarean section. For MC twins, statistical differences in outcome by mode of delivery could not be seen.

Original language	English
Journal	Acta Obstetricia et Gynecologica Scandinavica
Volume	91
Issue number	4
Pages (from-to)	463-9
Number of pages	7
ISSN	0001-6349
DOIs	https://doi.org/10.1111/j.1600-0412.2011.01356.x
Publication status	Published - Apr 2012

Keywords

Adult
Apgar Score
Cesarean Section
Cohort Studies
Delivery, Obstetric
Female
Humans
Infant Mortality
Infant, Newborn
Intensive Care, Neonatal
Multivariate Analysis
Odds Ratio
Parturition
Pregnancy
Pregnancy Outcome
Pregnancy, Twin
Retrospective Studies
Risk
Twins, Dizygotic
Twins, Monozygotic

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/j.1600-0412.2011.01356.x

Cite this

@article{6c4d7076026342f7992e253de9e7122c,

title = "Twin births: cesarean section or vaginal delivery?",

abstract = "Objective. To assess morbidity and mortality in twin pregnancy deliveries, according to chorionicity and mode of delivery. Design. Population-based retrospective cohort. Setting. Fourteen obstetric departments in Denmark. Population. One thousand one hundred and seventy-five twin pregnancies with two live fetuses at 36 +0 weeks of gestation. Methods. Pregnancy outcomes assessed according to chorionicity and mode of delivery. Main outcome measures. Poor outcome defined as five min Apgar score ≤ 7, umbilical artery pH < 7.10, admission to neonatal unit for more than three days or death. Results. Dichorionic (DC) twins, delivered after 36 gestational weeks, with intended vaginal delivery (n= 689) compared with DC twins with planned cesarean section (n= 371) had an increased risk of poor outcome [odds ratio (OR) 1.47, p= 0.037] after adjustment for body mass index, parity and weight discordance. There was no increased risk for poor outcome in monochorionic (MC) twins with intended vaginal delivery (n= 63) compared with planned cesarean section (n= 52; OR 0.87, 95% confidence interval 0.26-2.96). Nulliparity increased the risk of poor outcome in DC (OR 1.5, p= 0.03) and in MC twins (OR 4.01, p= 0.02), as well as birthweight discordance >300 g (DC, OR 1.50, p= 0.02; and MC, OR 6.02, p= 0.002). For DC twins, we found a significantly higher risk of poor outcome of the second-born twin compared with the first (OR 1.64, p= 0.001). Conclusions. Dichorionic twins born after 36 weeks of gestation had a higher risk of poor outcome by intended vaginal delivery than by planned cesarean section. For MC twins, statistical differences in outcome by mode of delivery could not be seen.",

keywords = "Adult, Apgar Score, Cesarean Section, Cohort Studies, Delivery, Obstetric, Female, Humans, Infant Mortality, Infant, Newborn, Intensive Care, Neonatal, Multivariate Analysis, Odds Ratio, Parturition, Pregnancy, Pregnancy Outcome, Pregnancy, Twin, Retrospective Studies, Risk, Twins, Dizygotic, Twins, Monozygotic",

author = "Elise Hoffmann and Anna Oldenburg and Line Rode and Ann Tabor and Steen Rasmussen and Lillian Skibsted",

note = "{\textcopyright} 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica{\textcopyright} 2012 Nordic Federation of Societies of Obstetrics and Gynecology.",

year = "2012",

month = apr,

doi = "10.1111/j.1600-0412.2011.01356.x",

language = "English",

volume = "91",

pages = "463--9",

journal = "Acta Obstetricia et Gynecologica Scandinavica",

issn = "0001-6349",

publisher = "JohnWiley & Sons Ltd",

number = "4",

}

TY - JOUR

T1 - Twin births

T2 - cesarean section or vaginal delivery?

AU - Hoffmann, Elise

AU - Oldenburg, Anna

AU - Rode, Line

AU - Tabor, Ann

AU - Rasmussen, Steen

AU - Skibsted, Lillian

PY - 2012/4

Y1 - 2012/4

N2 - Objective. To assess morbidity and mortality in twin pregnancy deliveries, according to chorionicity and mode of delivery. Design. Population-based retrospective cohort. Setting. Fourteen obstetric departments in Denmark. Population. One thousand one hundred and seventy-five twin pregnancies with two live fetuses at 36 +0 weeks of gestation. Methods. Pregnancy outcomes assessed according to chorionicity and mode of delivery. Main outcome measures. Poor outcome defined as five min Apgar score ≤ 7, umbilical artery pH < 7.10, admission to neonatal unit for more than three days or death. Results. Dichorionic (DC) twins, delivered after 36 gestational weeks, with intended vaginal delivery (n= 689) compared with DC twins with planned cesarean section (n= 371) had an increased risk of poor outcome [odds ratio (OR) 1.47, p= 0.037] after adjustment for body mass index, parity and weight discordance. There was no increased risk for poor outcome in monochorionic (MC) twins with intended vaginal delivery (n= 63) compared with planned cesarean section (n= 52; OR 0.87, 95% confidence interval 0.26-2.96). Nulliparity increased the risk of poor outcome in DC (OR 1.5, p= 0.03) and in MC twins (OR 4.01, p= 0.02), as well as birthweight discordance >300 g (DC, OR 1.50, p= 0.02; and MC, OR 6.02, p= 0.002). For DC twins, we found a significantly higher risk of poor outcome of the second-born twin compared with the first (OR 1.64, p= 0.001). Conclusions. Dichorionic twins born after 36 weeks of gestation had a higher risk of poor outcome by intended vaginal delivery than by planned cesarean section. For MC twins, statistical differences in outcome by mode of delivery could not be seen.

AB - Objective. To assess morbidity and mortality in twin pregnancy deliveries, according to chorionicity and mode of delivery. Design. Population-based retrospective cohort. Setting. Fourteen obstetric departments in Denmark. Population. One thousand one hundred and seventy-five twin pregnancies with two live fetuses at 36 +0 weeks of gestation. Methods. Pregnancy outcomes assessed according to chorionicity and mode of delivery. Main outcome measures. Poor outcome defined as five min Apgar score ≤ 7, umbilical artery pH < 7.10, admission to neonatal unit for more than three days or death. Results. Dichorionic (DC) twins, delivered after 36 gestational weeks, with intended vaginal delivery (n= 689) compared with DC twins with planned cesarean section (n= 371) had an increased risk of poor outcome [odds ratio (OR) 1.47, p= 0.037] after adjustment for body mass index, parity and weight discordance. There was no increased risk for poor outcome in monochorionic (MC) twins with intended vaginal delivery (n= 63) compared with planned cesarean section (n= 52; OR 0.87, 95% confidence interval 0.26-2.96). Nulliparity increased the risk of poor outcome in DC (OR 1.5, p= 0.03) and in MC twins (OR 4.01, p= 0.02), as well as birthweight discordance >300 g (DC, OR 1.50, p= 0.02; and MC, OR 6.02, p= 0.002). For DC twins, we found a significantly higher risk of poor outcome of the second-born twin compared with the first (OR 1.64, p= 0.001). Conclusions. Dichorionic twins born after 36 weeks of gestation had a higher risk of poor outcome by intended vaginal delivery than by planned cesarean section. For MC twins, statistical differences in outcome by mode of delivery could not be seen.

KW - Adult

KW - Apgar Score

KW - Cesarean Section

KW - Cohort Studies

KW - Delivery, Obstetric

KW - Female

KW - Humans

KW - Infant Mortality

KW - Infant, Newborn

KW - Intensive Care, Neonatal

KW - Multivariate Analysis

KW - Odds Ratio

KW - Parturition

KW - Pregnancy

KW - Pregnancy Outcome

KW - Pregnancy, Twin

KW - Retrospective Studies

KW - Risk

KW - Twins, Dizygotic

KW - Twins, Monozygotic

U2 - 10.1111/j.1600-0412.2011.01356.x

DO - 10.1111/j.1600-0412.2011.01356.x

M3 - Journal article

C2 - 22432546

SN - 0001-6349

VL - 91

SP - 463

EP - 469

JO - Acta Obstetricia et Gynecologica Scandinavica

JF - Acta Obstetricia et Gynecologica Scandinavica

IS - 4

ER -

Twin births: cesarean section or vaginal delivery?

Abstract

Keywords

UN SDGs

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