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379: Monochorionic compared with dichorionic twin neonatal outcomes after planned vaginal delivery

      Objective

      To assess neonatal mortality and morbidity of twins according to chorionicity after planned vaginal delivery in carefully selected patients.

      Study Design

      The JUMODA study was a national prospective population-based cohort study of twin deliveries performed in 176 maternity units in France from 02/2014 to 03/2015. The primary outcome was a composite of intrapartum mortality and neonatal mortality and morbidity. In the primary analysis, neonatal outcomes of all twins born at or after 32 weeks of gestation after planned vaginal delivery in case of cephalic first twin were compared according to chorionicity, monochorionic or dichorionic pregnancies. We used multivariable logistic regression models to control for potential confounders. We conducted a sensitivity analysis with exclusion of twin pregnancies with intrauterine fetal deaths of either twin and twin-to-twin transfusion syndromes, and subgroup analyses for the first and second twin.

      Results

      Among the 4441 women with a cephalic first twin and a planned vaginal delivery at or after 32 weeks of gestation, 895 (20.2%) were carrying a monochorionic and 3546 (79.8%) a dichorionic twin pregnancy. The cesarean delivery rate was 17.4% in the monochorionic group and 20.1% in the dichorionic group (p=0.07). After adjustment for potential confounders, composite neonatal mortality and morbidity did not differ between the monochorionic and dichorionic group (2.6% compared with 2.2%; adjusted odds ratio 0.92 [95% CI 0.61-1.37]). Results were similar after exclusion of intrauterine fetal deaths and twin-to-twin transfusion syndromes (2.4% compared with 2.2%; adjusted odds ratio 0.93 [95% CI 0.61-1.44]). Subgroup analyses for the first and second twin failed to show differences for the primary outcome according to chorionicity.

      Conclusion

      Monochorionic compared with dichorionic twin pregnancies with a cephalic first twin are not associated with increased composite neonatal mortality and morbidity in case of planned vaginal delivery at or after 32 weeks of gestation.
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