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Planned Mode of Delivery of Preterm Twins and Neonatal and 2-Year Outcomes

Sentilhes, Loïc, MD, PhD; Lorthe, Elsa, RM, PhD; Marchand-Martin, Laetitia, MSc; Marret, Stéphane, MD, PhD; Ancel, Pierre-Yves, MD, PhD; Delorme, Pierre, MD; Goffinet, François, MD, PhD; Quere, Mathilde, MSc; Kayem, Gilles, MD, PhD for the Etude Epidémiologique sur les Petits Ages Gestationnels (EPIPAGE) 2 Obstetric Writing Group

doi: 10.1097/AOG.0000000000003004
Multiple Gestations: Original Research: PDF Only

OBJECTIVE: To assess neonatal and 2-year outcomes for preterm twins born after planned vaginal delivery compared with planned cesarean delivery.

METHODS: Women with preterm cephalic first twins delivered after preterm labor or preterm prelabor rupture of membranes from 24 0/7 to 34 6/7 weeks of gestation, with both fetuses alive at the beginning of labor, were identified from the national prospective population-based Etude Epidémiologique sur les Petits Ages Gestationnels 2 cohort study. Planned vaginal delivery was defined as vaginal delivery or cesarean delivery performed during labor. Planned cesarean delivery was considered if performed during labor for the indication of preterm twins or before labor whatever the indication. A propensity score analysis was used to compare planned vaginal delivery and planned cesarean delivery. Outcomes analyzed separately for the first and second twins were survival at discharge, survival at discharge without severe morbidity, and survival at 2 years of corrected age without neurosensory impairment.

RESULTS: Among the 932 women with a twin pregnancy, 549 were excluded mainly as a result of the first twin in noncephalic presentation, cause of delivery other than preterm labor or preterm prelabor rupture of membranes, at least one twin died before labor, and gestational age at delivery less than 24 weeks of gestation. The planned vaginal delivery group included 276 women and the planned cesarean delivery group 107. For first and second twins, survival at discharge (97.7% vs 98.3% and 95.6% vs 97.1%, respectively), survival at discharge without severe morbidity (91.6% vs 88.8% and 90.3% vs 84.5%, respectively), and survival at 2 years of corrected age without neurosensory impairment (96.0% vs 95.4% and 92.9% vs 90.8%, respectively) did not differ significantly between the planned vaginal delivery and planned cesarean delivery groups. Propensity score analysis showed that planned cesarean delivery was not associated with improved outcomes with the caveat that the infrequency of death and disability limited the statistical power of the study to detect potentially clinically meaningful differences between planned modes of delivery.

CONCLUSION: Planned cesarean delivery for women in preterm labor or with preterm prelabor rupture of membranes was not associated with improved neonatal outcomes or 2-year outcomes.

Planned cesarean delivery for women in preterm labor or with preterm prelabor rupture of membranes was not associated with improved neonatal or 2-year outcomes.

Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, and Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France; EPIUnit–Institute of Public Health, University of Porto, Porto, Portugal; the Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles-Nicolle University Hospital, Rouen, INSERM U1245, Genetics and Pathophysiology of Neurodevelopmental Disorders, Team 4 Neovasc, Institute of Research and Innovation in Biomedicine, Rouen School of Medicine, Normandy University, Normandy, and the Department of Obstetrics and Gynecology, Cochin, Broca, Hôtel Dieu Hospital, Assistance Publique-Hôpitaux de Paris, the Department of Obstetrics and Gynecology, Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, and Sorbonne Universités, UPMC Univ Paris 06, IFD, 4 Place Jussieu, 75252 PARIS cedex 05, Paris, France.

Corresponding author: Loïc Sentilhes, MD, PhD, Department of Obstetrics and Gynecology Bordeaux University Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France; email: loicsentilhes@hotmail.com.

EPIPAGE-2 was funded by the French Institute of Public Health Research/Institute of Public Health and its partners: the French Health Ministry, the National Institute of Health and Medical Research (INSERM), the National Institute of Cancer, and the National Solidarity Fund for Autonomy (CNSA); the National Research Agency through the French EQUIPEX program of investments for the future (reference ANR-11-EQPX-0038); and the PREMUP Foundation. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Financial Disclosure Loïc Sentilhes carried out consultancy work and was a lecturer for Ferring Laboratories in the previous 3 years. The other authors did not report any potential conflicts of interest.

Presented in part at the annual meeting of the Society for Maternal-Fetal Medicine, January 29–February 3, 2018, Dallas, Texas.

* For a list of members of the EPIPAGE-2 Obstetric Writing Group, see Appendix 1, available online at http://links.lww.com/AOG/B222.

The authors thank the participating children and their families, all the participating maternity and neonatal units in France, and Laura Smales for editorial assistance.

The authors have confirmed compliance with the journal’s requirements for authorship.

Peer reviews and author correspondence are available at http://links.lww.com/AOG/B223.

Received August 22, 2018

Received in revised form September 29, 2018

Accepted October 04, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.