Twin delivery and neonatal and infant mortality: a population-based study

Area of Science:

• Obstetrics and Gynecology
• Perinatal Medicine
• Neonatal Research

Background:

• Mode of delivery significantly impacts perinatal outcomes, especially in twin gestations.
• Very premature twin births present unique challenges for survival and neonatal health.
• Optimizing delivery strategies is crucial for improving twin survival rates.

Purpose of the Study:

• To investigate the influence of delivery mode on twin survival, with a focus on very premature births.
• To analyze the association between cesarean delivery and neonatal/infant mortality in twins.
• To evaluate the impact of delivery mode on Apgar scores in twin neonates.

Main Methods:

• Population-based historical cohort study utilizing North Carolina vital records (1988-1991).
• Inclusion criteria: 4428 pairs of live-born twins, birth weight ≥ 500g.
• Outcome measures: 5-minute Apgar score, neonatal death, infant death.

Main Results:

• Cesarean delivery reduced risks of low Apgar score and mortality by 50-60% for infants weighing 500-749g (P < .05).
• Benefits of cesarean delivery were more pronounced for the second twin compared to the first.
• No significant association between delivery mode and outcomes was observed for infants weighing >1000g.

Conclusions:

• Cesarean delivery for twins <1000g and increased vaginal delivery for twins >1000g may enhance perinatal survival.
• This strategy could lead to improved overall perinatal survival rates.
• The findings suggest a nuanced approach to delivery mode selection based on estimated fetal weight in twins.