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Twin births: cesarean section or vaginal delivery?
MedLine Citation:
PMID:  22229534     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Objective. To assess morbidity and mortality in twin pregnancy deliveries, according to chorionicity and mode of delivery. Design. Population-based retrospective cohort. Setting. 14 obstetric departments in Denmark. Population. 1 175 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 >3 days or death. Results. Dichorionic (DC) twins, delivered after 36 gestational weeks, with intended vaginal delivery (n = 689) compared to DC twins with planned cesarean section (n = 371) had an increased risk of poor outcome (OR 1.47, p = 0.037) after adjustment for BMI, parity and weight discordance. There was no increased risk for poor outcome in MC twins with intended vaginal delivery (n = 63) compared to planned cesarean section (n = 52) [odds ratio (OR 0.87; 95% confidence interval (CI) 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 gram (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 to the first (OR 1.64; p = 0.001). Conclusion. DC 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 reached.
Authors:
Elise Hoffmann; Anna Oldenburg; Line Rode; Ann Tabor; Steen Rasmussen; Lillian Skibsted
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-1-10
Journal Detail:
Title:  Acta obstetricia et gynecologica Scandinavica     Volume:  -     ISSN:  1600-0412     ISO Abbreviation:  -     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-1-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370343     Medline TA:  Acta Obstet Gynecol Scand     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2012 The Authors AOGS© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.
Affiliation:
Department of Obstetrics and Gynecology, Roskilde University Hospital, Roskilde, Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark, and National Board of Health, Health Statistics, Copenhagen, Denmark.
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