Respiratory morbidity in well-dated twins approaching term. What are the risks of elective delivery?

To evaluate morbidity, particularly respiratory, in well-dated, near-term twins delivered electively and to compare them to those delivered either spontaneously or for obstetric indications.

Charts from twin deliveries were reviewed for inclusion in this study. Inclusion criteria were well-dated twins (American College of Obstetricians and Gynecologists criteria for dating) and absence of (1) corticosteroids, (2) intravenous tocolysis, (3) lung maturity studies, (4) fetal malformations, (5) diabetes, and (6) medical indications for delivery in the elective delivery group. Those meeting the criteria were divided into elective and nonelective (both spontaneous and indicated) delivery groups. Outcome variables included incidence of transient tachypnea and respiratory distress syndrome in each group.

During the study period, 168 sets of twins met the admission criteria. Controlling for gestational age, no difference was noted in the incidence of respiratory distress syndrome, transient tachypnea and admission to the special care nursery. Infants born during the 36th week of gestation were more likely to be admitted to the special care nursery (37.8% vs. 10.6%, P < .05) and had a greater incidence of respiratory complications (23.2% vs. 6.7%, P < .01) than those born after 37 weeks. No difference was identified between the 37th and 38th weeks.

In this large series of well-dated twin pregnancies, there was no evidence of increased respiratory morbidity or special care nursery admissions with elective delivery at or beyond 37 weeks. Twins delivered during the 36th week of gestation had increased respiratory morbidity and special care nursery admissions.