ATLANTA – A policy of planned cesarean delivery provides no significant benefit, compared with a policy of planned vaginal delivery in cases involving uncomplicated twin pregnancies between 32 and 38 weeks gestation where the first twin is in cephalic presentation, according to 2-year findings from the Twin Birth Study.
Prior findings from the randomized trial demonstrated that a policy of planned cesarean delivery benefited neither the mother nor the baby, compared with a policy of planned vaginal delivery; there was no difference between the groups with respect to the primary outcome of fetal or neonatal death or serious neonatal morbidity. The current analysis looked at the secondary outcome – a composite outcome of death or neurodevelopmental delay in offspring at age 2 years.
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This composite outcome, corrected for gestational age at birth, occurred in 5.99% of 2,320 planned cesarean deliveries and in 5.83% of 2,283 planned vaginal deliveries (odds ratio, 1.04), Dr. Elizabeth Asztalos of the University of Toronto reported at the annual Pregnancy Meeting sponsored by the Society for Maternal-Fetal Medicine.
There also was no significant difference between the groups in the individual components of the composite outcome. Death occurred in 1.51% and 1.01% of deliveries in the planned cesarean and planned vaginal delivery groups, respectively (OR, 1.48). In the surviving children, neurodevelopmental delay occurred in 4.55% and 4.87% (OR, 0.95), Dr. Asztalos said.
The Twin Birth study enrolled only women with uncomplicated twin pregnancies between 32 and 38 weeks’ gestation with the first twin in cephalic presentation. Subjects were randomized to either a planned cesarean or planned vaginal delivery group, and for the current analysis, children were assessed, using the Ages and Stages Questionnaire, at a mean age of 25-26 months in both groups.
Abnormal findings were validated by a clinical neurodevelopmental assessment.
The rate of cerebral palsy was extremely low in the study population and was not amenable to analysis, Dr. Asztalos said.
A post hoc analysis to determine if there were any differences between twin A and twin B with respect to the secondary outcome measure, showed no significant difference based on birth order, she added.
Notably, the incidence of the primary outcome in the study was almost threefold higher than the 2% originally anticipated in the planned vaginal delivery group. This may be due to the fact that for both approaches to delivery management, just under half of the infants were born preterm, she said.
The 2-year follow-up of the Twin Birth Study reinforces the initial findings of the international study, she said.
The Twin Birth Study was sponsored by Sunnybrook Health Sciences Centre in Toronto.