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Twin Birth Study: 2-year neurodevelopmental follow-up of the randomized trial of planned cesarean or planned vaginal delivery for twin pregnancy.

Abstract：

BACKGROUND:The Twin Birth Study randomized women with uncomplicated pregnancies, between 32(0/7)-38(6/7) weeks' gestation where the first twin was in cephalic presentation, to a policy of either a planned cesarean or planned vaginal delivery. The primary analysis showed that planned cesarean delivery did not increase or decrease the risk of fetal/neonatal death or serious neonatal morbidity as compared with planned vaginal delivery. OBJECTIVE:This study presents the secondary outcome of death or neurodevelopmental delay at 2 years of age. STUDY DESIGN:A total of 4603 children from the initial cohort of 5565 fetuses/infants (83%) contributed to the outcome of death or neurodevelopmental delay. Surviving children were screened using the Ages and Stages Questionnaire with abnormal scores validated by a clinical neurodevelopmental assessment. The effect of planned cesarean vs planned vaginal delivery on death or neurodevelopmental delay was quantified using a logistic model to control for stratification variables and using generalized estimating equations to account for the nonindependence of twin births. RESULTS:Baseline maternal, pregnancy, and infant characteristics were similar. Mean age at assessment was 26 months. There was no significant difference in the outcome of death or neurodevelopmental delay: 5.99% in the planned cesarean vs 5.83% in the planned vaginal delivery group (odds ratio, 1.04; 95% confidence interval, 0.77-1.41; P = .79). CONCLUSION:A policy of planned cesarean delivery provides no benefit to children at 2 years of age compared with a policy of planned vaginal delivery in uncomplicated twin pregnancies between 32(0/7)-38(6/7)weeks' gestation where the first twin is in cephalic presentation.

journal_name

Am J Obstet Gynecol

journal_title

American journal of obstetrics and gynecology

authors

Asztalos EV,Hannah ME,Hutton EK,Willan AR,Allen AC,Armson BA,Gafni A,Joseph KS,Ohlsson A,Ross S,Sanchez JJ,Mangoff K,Barrett JF

doi

10.1016/j.ajog.2015.12.051

subject

Has Abstract

pub_date

2016-03-01 00:00:00

pages

371.e1-371.e19

issue

eissn

0002-9378

issn

1097-6868

pii

S0002-9378(15)02655-1

journal_volume

214

pub_type

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Twin Birth Study: 2-year neurodevelopmental follow-up of the randomized trial of planned cesarean or planned vaginal delivery for twin pregnancy.