Influence of mode of delivery on perinatal outcome and neurodevelopment
in monochorionic diamniotic twins: A single-center retrospective cohort
study
Abstract
Objective: To study the influence of the mode of delivery in
uncomplicated monochorionic diamniotic (MCDA) twins ≥ 32 weeks of
gestation. Design: Single-center retrospective cohort study. Setting:
Department of Materno Fetal Medicine. Virgen del Rocío University
Hospital. Population or sample: A total of 72 MCDA twins between 2012
and 2018. Methods: Outcomes were compared between women who underwent a
trial of labor (TOL) (induced or spontaneous onset of labor) and those
who underwent a planned cesarean section (PCS). Main outcome measures:
(1) A composite of any of the following: neonatal death, 5-minute Apgar
score <4, respiratory distress syndrome, bronchopulmonary
dysplasia, sepsis, periventricular leukomalacia, intraventricular
hemorrhage, and necrotizing enterocolitis. (2) Neurodevelopmental
impairment (NDI) at 2 years of corrected age. Results: In this period,
42 women (58.3%) had a TOL and 30 women (41.7%) had a PCS. In the TOL
group, 64.3% achieved vaginal delivery. The rate of successful vaginal
delivery was similar regardless of whether the onset of labor was
spontaneous or induced. Composite perinatal morbidity was higher in the
PCS group (aOR 1.36, 95% CI 0.24-7.81) and, considering the onset of
labor, it was more frequent in the spontaneous subgroup (8.3% vs. 0%).
The rate of NDI was higher in the PCS group [10.2% vs. 4.9%, aOR
1.53 (95% CI 0.37-6.29)]. Conclusions: In uncomplicated MCDA twins at
≥ 32 weeks of gestation, when the first twin is in vertex presentation,
trial of labor is a safe approach with a successful outcome and high
vaginal delivery rate.