Abstract:
BACKGROUND:One of the controversies in the management of twin gestations relates to mode of delivery, especially when the second twin is in a nonvertex presentation (Vertex/nonVertex pairs) and birth is imminent at extremely low gestation. OBJECTIVE:We hypothesized that, for Vertex/nonVertex twins born before 28 weeks' gestation, cesarean delivery would be associated with a lower risk of adverse neonatal outcomes than trial of vaginal delivery. Our aim was to test this hypothesis by comparing the neonatal outcomes of Vertex/nonVertex twins born before 28 weeks' gestation by mode of delivery using a large national cohort. STUDY DESIGN:This work is a retrospective cohort study of all twin infants born at 240/7 to 276/7 weeks' gestation and admitted to level III neonatal intensive care units participating in the Canadian Neonatal Network (2010-2017). Exposure is defined a trial of vaginal delivery for Vertex/nonVertex twins. Nonexposed (control) groups are defined as cases where both twins were delivered by cesarean delivery, either in vertex or nonvertex presentation (control group 1) or owing to the nonvertex presentation of the first twin (control group 2). Outcome measures are defined as a composite of neonatal death, severe neurologic injury, or birth trauma. RESULTS:A total of 1082 twin infants (541 twin pairs) met the inclusion criteria: 220 Vertex/nonVertex pairs, of which 112 had a trial of vaginal delivery (study group) and 108 had cesarean delivery for both twins (control group 1); 170 pairs with the first twin in nonvertex presentation, all of which were born by cesarean delivery (control group 2); and 151 pairs with both twins in vertex presentation (vertex or nonvertex). In the study group, the rate of urgent cesarean delivery for the second twin was 30%. The rate of the primary outcome in the study group was 42%, which was not significantly different compared with control group 1 (37%; adjusted relative risk, 0.93; 95% confidence interval, 0.71-1.22) or control group 2 (34%; adjusted relative risk, 1.20; 95% confidence interval, 0.92-1.58). The findings remained similar when outcomes were analyzed separately for the first and second twins. CONCLUSION:For preterm Vertex/nonVertex twins born at <28 weeks' gestation, we found no difference in the risk of adverse neonatal outcome between a trial of vaginal delivery and primary cesarean delivery. However, a trial of vaginal delivery was associated with a high rate of urgent cesarean delivery for the second twin.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Hiersch L,Shah PS,Khurshid F,Masse E,Murphy K,McDonald SD,Carson G,Barrett J,Melamed N,Canadian Neonatal Network Investigators and the Canadian Preterm Birth Network Investigators.doi
10.1016/j.ajog.2020.12.002subject
Has Abstractpub_date
2020-12-09 00:00:00eissn
0002-9378issn
1097-6868pii
S0002-9378(20)31368-5pub_type
杂志文章abstract::Sixty patients with chronic pelvic pain were monitored after diagnostic laparoscopy had excluded obvious pelvic pathology. Six months after the procedure only two patients described their symptoms as unchanged or worse. Treatment should be limited to the minority of patients whose symptoms remain 6 months after laparo...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(92)91343-9
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abstract::The pulsatile release of gonadotropin-releasing hormone and the consequent secretion of gonadotropins are regulated by a complex interplay of steroids, neuropeptides, catecholamines, and environmental factors. Estrogen and progesterone influence the amplitude and frequency of luteinizing hormone pulsatile secretion. T...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
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更新日期:1990-11-01 00:00:00
abstract::Multifetal gestation is associated with increased frequency of maternal complications and higher perinatal morbidity and mortality. The need for contemporary data on the outcome of multifetal gestations is further underscored when selective reduction is considered. The present study details the obstetric management, n...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(90)90407-x
更新日期:1990-02-01 00:00:00
abstract:OBJECTIVE:Our purpose was to investigate a possible ionic basis linking pregnancy and gestational diabetes with the vascular disorders associated with them. STUDY DESIGN:We used phosphorus 31 nuclear magnetic resonance spectroscopy and magnesium- and calcium-specific ion electrodes to measure erythrocyte intracellular...
journal_title:American journal of obstetrics and gynecology
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doi:10.1016/0002-9378(95)90035-7
更新日期:1995-03-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to describe patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapse symptoms and to describe predictors of preference for uterine preservation. STUDY DESIGN:This multicenter, cross-sectional study evaluated patient preferences for uterin...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,多中心研究
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更新日期:2013-11-01 00:00:00
abstract::There is growing evidence that the high prevalence of low-birth-weight (LBW) babies, a characteristic of many poor societies, can be significantly reduced through nutritional intervention programs. In order to increase the efficiency of these programs, pregnant women at risk of delivering LBW babies must be identified...
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abstract:OBJECTIVE:To assess the effectiveness of inner thigh "Taping" compared with "Traction" using a weighted bag when an intracervical Foley catheter is used for cervical ripening. STUDY DESIGN:We performed a randomized controlled trial at a tertiary hospital on women with a singleton pregnancy in cephalic presentation adm...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,随机对照试验
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更新日期:2013-09-01 00:00:00
abstract::Although perimortem delivery has been recorded in the medical literature for millennia, the procedural intent has evolved to the current fetocentric approach, predicating timing of delivery following maternal cardiopulmonary arrest to optimize neonatal outcome. We suggest a call to action to reinforce the concept that...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
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更新日期:2015-11-01 00:00:00
abstract:OBJECTIVE:We sought to compare labor patterns by body mass index (BMI). STUDY DESIGN:A total of 118,978 gravidas with a singleton term cephalic gestation were studied. Repeated-measures analysis constructed mean labor curves by parity and BMI categories for those who reached 10 cm. Interval-censored regression analysi...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,多中心研究
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更新日期:2011-09-01 00:00:00
abstract::Motrin (ibuprofen), a potent inhibitor of prostaglandin synthetase, was tested in women and men for treatment of recurrences of genital herpes. In a double-blind trial, no statistically significant differences were observed between treated and placebo groups in any of the measured parameters. ...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章
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更新日期:1986-08-01 00:00:00
abstract::Fetal heart rate (FHR) is influenced by the central nervous system, cardiac automatism, biochemical factors, etc. Changes in FHR were correlated with the anatomic defect in autopsy material from 20 anencephalic infants, and, on this basis, the following hypotheses were formed, subject to later experimental proof. (1) ...
journal_title:American journal of obstetrics and gynecology
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更新日期:1984-05-15 00:00:00
abstract::A light and electron microscopic study was undertaken of the early phases of cervical squamous metaplasia. A study of areas of columnar epithelium with one row of subcolumnar cells revealed a spectrum of squamous differentiation ranging from cytologically undifferentiation to more characteristically basal type squamou...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(15)33239-7
更新日期:1980-07-15 00:00:00
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journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1997-10-01 00:00:00
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journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(84)90283-7
更新日期:1984-05-01 00:00:00
abstract::This study attempts quantification of prostaglandins (PGs) in amniotic fluid antepartum at 24, 26-33, 34-36 weeks of gestation and in labor in 6 normal patients, 6 diabetic patients, 3 patients taking methadone, and 1 patient taking heroin. Results of measurements of PGs showed that in the different weeks of gestatio...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
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更新日期:1974-02-01 00:00:00
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journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2003.68
更新日期:2003-02-01 00:00:00
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journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1016/j.ajog.2005.03.063
更新日期:2005-11-01 00:00:00
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更新日期:1994-09-01 00:00:00
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pub_type: 杂志文章,评审
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更新日期:1992-02-01 00:00:00
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更新日期:1984-08-15 00:00:00
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更新日期:2010-05-01 00:00:00
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更新日期:2008-12-01 00:00:00
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journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(87)90055-x
更新日期:1987-03-01 00:00:00
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journal_title:American journal of obstetrics and gynecology
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更新日期:1985-04-15 00:00:00
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更新日期:2015-01-01 00:00:00
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journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
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更新日期:2013-02-01 00:00:00
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journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
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更新日期:1978-04-01 00:00:00
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journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
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更新日期:1980-05-01 00:00:00