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24: Twin birth study: 2-year follow-up of the randomized trial comparing planned cesarean vs planned vaginal delivery for twin pregnancy

      Objective

      The Twin Birth Study enrolled women with uncomplicated twin pregnancies, between 32 and 38 weeks gestation where the first twin was in cephalic presentation, who were randomized to a policy of either a planned caesarean or planned vaginal delivery. A planned caesarean delivery did not increase or decrease the risk of fetal or neonatal death or serious neonatal morbidity as compared with a planned vaginal delivery. A secondary outcome for the trial was a composite of death or neurodevelopmental delay at 2 years of age. This report presents the 2-year outcomes of the Twin Births Study.

      Study Design

      A total of 4603 children (83% of the 5565 fetuses eligible from the initial trial) contributed to the outcome of death or neuro-developmental delay at 2 years of age. Surviving children were screened using the Ages and Stages Questionnaire. Abnormal scores were validated by a Clinical Neuro-developmental Assessment to confirm the presence or absence of a delay. The outcome of death or neuro-developmental delay was compared between the treatment groups with a logistic model to control for stratification variables and using generalized estimating equations to account for the non-independence of twin births.

      Results

      Baseline maternal, pregnancy, and infant characteristics were similar between the two groups. The mean age at assessment was between 25-26 months. There was no significant difference in the outcome of death or neuro-developmental delay: 5.99% in the planned caesarean vs. 5.83% in the planned vaginal delivery group [OR 1.04, 95% CI 0.77, 1.41, p= 0.79].

      Conclusion

      A policy of planned caesarean delivery provides no significant benefit in children at 2 years of age compared with a policy of planned vaginal delivery in uncomplicated twin pregnancies between 32 and 38 weeks gestation where the first twin is in cephalic presentation.
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