For a study, researchers sought to determine the survival without severe Neonatal Morbidity for twins delivered before 32 weeks of gestation using the scheduled route of delivery. JUMODA (JUmeaux MODe accouchement) was a French national prospective, population-based cohort study of twin births from February 2014 to March 2015. The secondary study comprised diamniotic twin pregnancies ranging in gestational age from 26 0/7 to 31 6/7 weeks. Exclusion criteria included contraindications to vaginal birth and cases when planned cesarean delivery was preferred because infant survival was mostly determined by the underlying disease rather than the mode of delivery. The major goal was to ensure that no serious newborn morbidity occurred throughout the study (bronchopulmonary dysplasia, grade 3 or grade 4 intraventricular hemorrhage, periventricular leukomalacia, stage 2 or stage 3 necrotizing enterocolitis). A multivariate Poisson regression model was used to examine the relationship between the anticipated delivery method and primary outcome. A propensity-score technique with the inverse likelihood of treatment weighting was also used to account for indication bias. Subgroup analysis based on birth order and sensitivity analyses confined to spontaneous preterm deliveries were carried out.
Among 424 extremely preterm twin pregnancies, 192 (45.3%) were scheduled for cesarean birth, and 232 (54.7%) were scheduled for vaginal delivery. There was no difference in survival to discharge without severe morbidity between the two groups: 308 of 384 (80.2%) after planned cesarean and 375 of 464 (80.8%) after planned vaginal delivery (crude relative risk 0.99; 95% CI 0.91–1.15; adjusted relative risk 1.02; 95% CI 0.93–1.11). Even after adjusting for the inverse likelihood of treatment weighting, planned cesarean delivery was not associated with a greater discharge rate without serious newborn morbidity than planned vaginal birth (relative risk 1.11; 95% CI 0.84–1.46). The findings of subgroup and sensitivity analysis were comparable. Planned cesarean birth for extremely preterm twins was not related to a greater rate of survival to discharge without serious newborn morbidity than planned vaginal delivery. The findings implied that extremely preterm delivery should not be regarded as a primary reason for scheduled cesarean section in twin pregnancies.
