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Am J Obstet Gynecol. 2005 Jan;192(1):252-6.

The influence of mode of delivery on twin neonatal mortality in the US: variance by birth weight discordance.

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1
Division of Maternal-Fetal Medicine, Roberto Wood Johnson University Hospital/Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ, USA.

Abstract

OBJECTIVE:

The purpose of this study was to examine if neonatal mortality rates (NMR) based on birth weight discordance (BWD) differ based on mode of delivery.

STUDY DESIGN:

The population-based US "matched multiple birth" database (1995 to 1998) was used to examine the effect of vaginal/vaginal (VV) and cesarean/cesarean (CC) modes of delivery (MOD) on neonatal mortality (<28 days after birth). Births at <32 weeks, congenital malformations, chromosomal anomalies, and discordant MOD (vaginal/cesarean) were excluded. The association between MOD (with CC as the reference) and neonatal mortality was expressed as relative risks (RR) with 95% CI, derived from logistic regression models.

RESULTS:

The NMR increased with increasing degrees of BWD regardless of mode of delivery. CC was associated with decreased NMR when BWD was between 20% and 40%, but this reached significance at BWD > or =40%; VV pairs had a 1.6-fold (95% CI 1.1-2.2) increased NMR compared with CC.

CONCLUSION:

In twins with BWD <40%, MOD has no effect on NMR. Beyond or equal to 40% discordance, there was lower NMR with cesarean-cesarean delivery.

PMID:
15672033
DOI:
10.1016/j.ajog.2004.05.056
[Indexed for MEDLINE]
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