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Mode of delivery and the risk of delivery-related perinatal death among twins at term: a retrospective cohort study of 8073 births.
BJOG. 2005 Aug; 112(8):1139-44.BJOG

Abstract

OBJECTIVE

To determine the risk of perinatal death among twins born at term in relation to mode of delivery.

DESIGN

Retrospective cohort study.

SETTING

Scotland 1985-2001.

POPULATION

All twin births at or after 36 weeks of gestation, excluding antepartum stillbirths and perinatal deaths due to congenital abnormality (n= 8073).

METHODS

The outcome of first and second twins was compared using McNemar's test and the outcome of twin pairs in relation to mode of delivery was compared using exact logistic regression.

MAIN OUTCOME MEASURES

Intrapartum stillbirth or neonatal death of either twin.

RESULTS

Overall, there were six deaths of first twins and 30 deaths of second twins (OR for second twin 5.00, 95% CI 2.00-14.70). The odds ratio for death of the second twin due to intrapartum anoxia was 21 (95% CI 3.4-868.5). The associations were similar for twins delivered following induction of labour and for sex discordant twins. However, there was no association between birth order and the risk of death among 1472 deliveries by planned caesarean section. There was death of either twin among 2 of 1472 (0.14%) deliveries by planned caesarean section and 34 of 6601 (0.52%) deliveries by other means (P= 0.05, odds ratio for planned caesarean section 0.26 [95% CI 0.03-1.03]). The association was similar when adjusted for potential confounders. Assuming causality, we estimate that 264 caesarean deliveries (95% CI 158-808) would be required to prevent each death.

CONCLUSION

Planned caesarean section may reduce the risk of perinatal death of twins at term by approximately 75% compared with attempting vaginal birth. This is principally due to reducing the risk of death of the second twin due to intrapartum anoxia.

Authors+Show Affiliations

Department of Obstetrics and Gynaecology, Cambridge University, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16045531

Citation

Smith, Gordon C S., et al. "Mode of Delivery and the Risk of Delivery-related Perinatal Death Among Twins at Term: a Retrospective Cohort Study of 8073 Births." BJOG : an International Journal of Obstetrics and Gynaecology, vol. 112, no. 8, 2005, pp. 1139-44.
Smith GC, Shah I, White IR, et al. Mode of delivery and the risk of delivery-related perinatal death among twins at term: a retrospective cohort study of 8073 births. BJOG. 2005;112(8):1139-44.
Smith, G. C., Shah, I., White, I. R., Pell, J. P., & Dobbie, R. (2005). Mode of delivery and the risk of delivery-related perinatal death among twins at term: a retrospective cohort study of 8073 births. BJOG : an International Journal of Obstetrics and Gynaecology, 112(8), 1139-44.
Smith GC, et al. Mode of Delivery and the Risk of Delivery-related Perinatal Death Among Twins at Term: a Retrospective Cohort Study of 8073 Births. BJOG. 2005;112(8):1139-44. PubMed PMID: 16045531.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mode of delivery and the risk of delivery-related perinatal death among twins at term: a retrospective cohort study of 8073 births. AU - Smith,Gordon C S, AU - Shah,Imran, AU - White,Ian R, AU - Pell,Jill P, AU - Dobbie,Richard, PY - 2005/7/28/pubmed PY - 2005/9/15/medline PY - 2005/7/28/entrez SP - 1139 EP - 44 JF - BJOG : an international journal of obstetrics and gynaecology JO - BJOG VL - 112 IS - 8 N2 - OBJECTIVE: To determine the risk of perinatal death among twins born at term in relation to mode of delivery. DESIGN: Retrospective cohort study. SETTING: Scotland 1985-2001. POPULATION: All twin births at or after 36 weeks of gestation, excluding antepartum stillbirths and perinatal deaths due to congenital abnormality (n= 8073). METHODS: The outcome of first and second twins was compared using McNemar's test and the outcome of twin pairs in relation to mode of delivery was compared using exact logistic regression. MAIN OUTCOME MEASURES: Intrapartum stillbirth or neonatal death of either twin. RESULTS: Overall, there were six deaths of first twins and 30 deaths of second twins (OR for second twin 5.00, 95% CI 2.00-14.70). The odds ratio for death of the second twin due to intrapartum anoxia was 21 (95% CI 3.4-868.5). The associations were similar for twins delivered following induction of labour and for sex discordant twins. However, there was no association between birth order and the risk of death among 1472 deliveries by planned caesarean section. There was death of either twin among 2 of 1472 (0.14%) deliveries by planned caesarean section and 34 of 6601 (0.52%) deliveries by other means (P= 0.05, odds ratio for planned caesarean section 0.26 [95% CI 0.03-1.03]). The association was similar when adjusted for potential confounders. Assuming causality, we estimate that 264 caesarean deliveries (95% CI 158-808) would be required to prevent each death. CONCLUSION: Planned caesarean section may reduce the risk of perinatal death of twins at term by approximately 75% compared with attempting vaginal birth. This is principally due to reducing the risk of death of the second twin due to intrapartum anoxia. SN - 1470-0328 UR - https://www.unboundmedicine.com/medline/citation/16045531/Mode_of_delivery_and_the_risk_of_delivery_related_perinatal_death_among_twins_at_term:_a_retrospective_cohort_study_of_8073_births_ L2 - https://doi.org/10.1111/j.1471-0528.2005.00631.x DB - PRIME DP - Unbound Medicine ER -