Am J Perinatol 2014; 31(05): 365-372
DOI: 10.1055/s-0033-1334458
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Short-Term Neonatal Outcomes in Diamniotic Twin Pregnancies Delivered after 32 Weeks and Indications of Late Preterm Deliveries

Alireza A. Shamshirsaz
1   Department of Obstetrics and Gynecology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
2   Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut
,
Samadh F. Ravangard
2   Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut
,
Ali Ozhand
3   Department of Preventive Medicine, USC Keck School of Medicine, Los Angeles, California
,
Sina Haeri
1   Department of Obstetrics and Gynecology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
,
Amirhoushang A. Shamshirsaz
4   Department of Obstetrics and Gynecology, The George Washington University School of Medicine, Washington, District of Columbia
,
Naveed Hussain
5   Department of Pediatrics, University of Connecticut Health Center, Farmington, Connecticut
,
Melissa Spiel
2   Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut
,
Oluseyi Ogunleye
6   Department of Obstetrics and Gynecology, Waverly Women's Health Care, Columbia, South Carolina
,
Rachel Billstrom
2   Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut
,
Alison Sadowski
2   Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut
,
Garry Turner
2   Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut
,
Diane Timms
2   Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut
,
James F. X. Egan
2   Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut
,
Winston A. Campbell
2   Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut
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Weitere Informationen

Publikationsverlauf

25. Dezember 2012

02. Januar 2013

Publikationsdatum:
28. Oktober 2013 (online)

Abstract

Objective We sought to compare neonatal outcomes in twin pregnancies following moderately preterm birth (MPTB), late preterm birth (LPTB), and term birth and determine the indications of LPTB.

Study Design We performed a retrospective cohort study. MPTB was defined as delivery between 320/7 and 336/7 weeks and LPTB between 340/7 and 366/7 weeks. The composite neonatal adverse respiratory outcome was defined as respiratory distress syndrome and/or bronchopulmonary dysplasia. The composite neonatal adverse nonrespiratory outcome included early onset culture-proven sepsis, necrotizing enterocolitis, retinopathy of prematurity, intraventricular hemorrhage, or periventricular leukomalacia. LPTB cases were categorized as spontaneous (noniatrogenic), evidence-based iatrogenic, and non-evidence-based (NEB) iatrogenic.

Results Of the 747 twin deliveries during the study period, 453 sets met the inclusion criteria with 22.7% (n = 145) MPTB, 32.1% (n = 206) LPTB, and 15.9% (n = 102) term births. Compared with term neonates, the composite neonatal adverse respiratory outcome was increased following MPTB (relative risk [RR] 24; 95% confidence interval [CI] 3.0 to 193.6) and LPTB (RR 13.7; 95% CI 1.8 to 101.8). Compared with term neonates, the composite neonatal adverse nonrespiratory outcome was increased following MPTB (RR 22.3; 95% CI 3.9 to 127.8) and LPTB (RR 5.5; 95% CI 1.1 to 27.6). Spontaneous delivery of LPTB was 63.6% (n = 131/206) and the rate of iatrogenic delivery was 36.4% (n = 75/206). The majority, 66.6% (n = 50/75), of these iatrogenic deliveries were deemed NEB, giving a total of 24.2% (50/206) NEB deliveries in LPTB group.

Conclusion Our data demonstrate a high rate of late preterm birth among twin pregnancies, with over half of nonspontaneous early deliveries due to NEB indications. Although our morbidity data will be helpful to providers in counseling patients, our finding of high NEB indications underscores the need for systematic evaluation of indications for delivery in LPTB twin deliveries. Furthermore, this may lead to more effective LPTB rate reduction efforts.

 
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