Vaginal birth as compared with cesarean section in preterm twins-Experience from a tertiary center of a middle-income country.

ABSTRACT

OBJECTIVES: To evaluate the mode of birth in early-preterm, late-preterm, and near-term twins as well as to compare the maternal and neonatal outcomes of each group following vaginal birth (VB) and lower-segment cesarean section (LSCS). METHODS: A prospective cohort study was conducted of 100 twin pregnancies in a tertiary center between 2018 and 2019. Deliveries were allocated into the following three gestational age groups (weeks ± days) and compared (1) early-preterm (28 to 31 ± 6), (2) late-preterm (32 to 35 ± 6), and (3) near-term (≥36 weeks). RESULTS: The proportion of VB and LSCS were similar when early-preterm twins (P = 0.766; relative risk [RR], 1.08) and late-preterm twins (P = 0.071; RR, 1.21) were compared separately with near-term twins. Perinatal outcomes did not differ between VB and LSCS within each gestational age group. When compared with the near-term group, the early-preterm group had more hypoglycemia (P < 0.001), hyperbilirubinemia (P < 0.001), respiratory distress (P < 0.001), low APGAR scores (P < 0.001), and death (P < 0.001) irrespective of the mode of birth. The late-preterm group had lower morbidity and mortality (P = 0.227). Postpartum hemorrhage and blood transfusion were similar between the groups. CONCLUSION: The proportion of VB and LSCS and associated maternal and neonatal outcomes did not differ in twins of different gestational ages. The data provide reassurance to practitioners to perform vaginal delivery in preterm twins.