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16 Survival without severe neonatal morbidity in very preterm twins according to planned mode of delivery

      Objective

      To assess survival at discharge without severe neonatal morbidity according to the planned mode of delivery for preterm twins born before 32 weeks of gestation.

      Study Design

      JUMODA (JUmeaux MOde D’Accouchement) was a national prospective population-based cohort study of twin deliveries performed in 176 maternity units in France from 02/2014 to 03/2015. In this planned secondary analysis, we included low risk diamniotic twin pregnancies between 26 and 32 weeks of gestation without contra-indication for vaginal delivery. Suspected fetal growth restrictions and twin-to-twin transfusion syndromes were excluded. The primary outcome was survival at discharge without severe neonatal morbidity defined as one or more of the following: bronchopulmonary dysplasia, grade-3 or -4 intraventricular hemorrhage, periventricular leukomalacia, and stage-2 or -3 necrotizing enterocolitis. The association between planned mode of delivery and survival without severe neonatal morbidity was assessed by multivariate Poisson regression model with adjustment for potential confounders. A propensity score approach with inverse probability of treatment weighting (IPTW) was also performed to control indication bias.

      Results

      Of the 424 twin pregnancies included in this analysis, 232 (54.7%) had planned vaginal delivery and 192 (45.3%) planned cesarean delivery. Survival at discharge without severe morbidity did not differ in very preterm twins born after planned vaginal (375/464 (80.8%) and planned cesarean delivery (308/384 (80.2%), P=0.82, aRR 1.01, 95%CI 0.89-1.15). After applying propensity scores and assigning IPTW, compared with planned vaginal delivery, planned cesarean delivery was not associated with improved survival at discharge without severe neonatal morbidity (RR 1.11, 95%IC 0.84-1.46). Results were similar for first and second twins analyzed separately (respectively aRR 0.95, 95%CI 0.82-1.09 and aRR 1.05, 95%CI 0.92-1.20).

      Conclusion

      Compared with planned vaginal delivery, planned cesarean delivery for very preterm twins is not associated with greater survival at discharge without severe neonatal morbidity.
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