Objective: To determine a possible relationship between neonatal and maternal outcomes in twin gestations and the planned mode of delivery. Study design: A single-centre retrospective cohort study in twins ≥32 weeks ...Objective: To determine a possible relationship between neonatal and maternal outcomes in twin gestations and the planned mode of delivery. Study design: A single-centre retrospective cohort study in twins ≥32 weeks of gestational age was performed. Baseline characteristics, and neonatal and maternal outcomes were documented according to the planned mode of delivery: a planned caesarean section or a planned vaginal birth. Statistical analysis was performed using chi-square test. Fisher exact test was used in case correction was needed. Results: During the study period (1999-2002), 164 twins ≥32 weeks were enrolled in the study. In 29 women (17.7%) an elective caesarean section was performed. The remaining 135 twins (82.3%) were allowed to start a vaginal delivery. An emergency or an urgent secondary caesarean section for both twins was performed in 26 women, and in 2 women for twin B only. One twin B baby died during planned vaginal delivery. No significant differences in perinatal mortality and serious neonatal morbidity were found between both groups (10.3%versus 9.6%). Neonatal outcomes in twins A were significantly better than in twins B (2.4%versus 7.3%), independent of the planned mode of delivery. Serious maternal morbidity was not significantly different between both groups (13.8%versus 19.3%), although 2 women in the elective caesarean section group needed a relaparotomy for haemorrhage. Conclusion: Our results do not support an elective caesarean section for twin gestations ≥32 weeks. The success rate of vaginal delivery in the planned vaginal birth group was nearly 80%.展开更多
Objective: The purpose of this prospective cohort study was to determine whether planned vaginal delivery for the term singleton baby in breech position increases the risk of abnormal neurodevelopment at 2 years of ag...Objective: The purpose of this prospective cohort study was to determine whether planned vaginal delivery for the term singleton baby in breech position increases the risk of abnormal neurodevelopment at 2 years of age and to assess whether the effect is modified by birth weight. Study design: At 2 years of age, all nonrandomized children born in breech position during our participation in the Term Breech Trial were screened for abnormal neurodevelopment with the Ages and Stages Questionnaire. Results: An Ages and Stages Questionnaire at 2 years of age was obtained in 183 of 203 children (90.1% ). Twenty- eight percent of these children showed 1 or more abnormal Ages and Stages Questionnaire domains. There were no differences in the risk of having abnormal Ages and Stages Questionnaire domains between planned vaginal delivery and planned cesarean section (P = .99). There was, however, evidence of interaction between mode of delivery and birthweight, with significantly higher risk in neurodevelopmental delay in children with birth weight greater than 3500 g with planned vaginal birth (adjusted odds ratio for interaction term 3.37; 95% confidence interval 1.14 to 9.95).Conclusion: Based on the Ages and Stages Questionnaire results at 2 years of age, planned vaginal delivery is associated with an increased risk of neurodevelopmental delay at 2 years of age in term breech children with a birthweight greater than 3500 g.展开更多
文摘Objective: To determine a possible relationship between neonatal and maternal outcomes in twin gestations and the planned mode of delivery. Study design: A single-centre retrospective cohort study in twins ≥32 weeks of gestational age was performed. Baseline characteristics, and neonatal and maternal outcomes were documented according to the planned mode of delivery: a planned caesarean section or a planned vaginal birth. Statistical analysis was performed using chi-square test. Fisher exact test was used in case correction was needed. Results: During the study period (1999-2002), 164 twins ≥32 weeks were enrolled in the study. In 29 women (17.7%) an elective caesarean section was performed. The remaining 135 twins (82.3%) were allowed to start a vaginal delivery. An emergency or an urgent secondary caesarean section for both twins was performed in 26 women, and in 2 women for twin B only. One twin B baby died during planned vaginal delivery. No significant differences in perinatal mortality and serious neonatal morbidity were found between both groups (10.3%versus 9.6%). Neonatal outcomes in twins A were significantly better than in twins B (2.4%versus 7.3%), independent of the planned mode of delivery. Serious maternal morbidity was not significantly different between both groups (13.8%versus 19.3%), although 2 women in the elective caesarean section group needed a relaparotomy for haemorrhage. Conclusion: Our results do not support an elective caesarean section for twin gestations ≥32 weeks. The success rate of vaginal delivery in the planned vaginal birth group was nearly 80%.
文摘Objective: The purpose of this prospective cohort study was to determine whether planned vaginal delivery for the term singleton baby in breech position increases the risk of abnormal neurodevelopment at 2 years of age and to assess whether the effect is modified by birth weight. Study design: At 2 years of age, all nonrandomized children born in breech position during our participation in the Term Breech Trial were screened for abnormal neurodevelopment with the Ages and Stages Questionnaire. Results: An Ages and Stages Questionnaire at 2 years of age was obtained in 183 of 203 children (90.1% ). Twenty- eight percent of these children showed 1 or more abnormal Ages and Stages Questionnaire domains. There were no differences in the risk of having abnormal Ages and Stages Questionnaire domains between planned vaginal delivery and planned cesarean section (P = .99). There was, however, evidence of interaction between mode of delivery and birthweight, with significantly higher risk in neurodevelopmental delay in children with birth weight greater than 3500 g with planned vaginal birth (adjusted odds ratio for interaction term 3.37; 95% confidence interval 1.14 to 9.95).Conclusion: Based on the Ages and Stages Questionnaire results at 2 years of age, planned vaginal delivery is associated with an increased risk of neurodevelopmental delay at 2 years of age in term breech children with a birthweight greater than 3500 g.
