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Does structured obstetric management play a role in the delivery mode and neonatal outcome of twin pregnancies?

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Název: Does structured obstetric management play a role in the delivery mode and neonatal outcome of twin pregnancies?
Autoři: Isabell Ge, Julia Meschede, Ingolf Juhasz-Boess, Mirjam Kunze, Filiz Markfeld-Erol
Zdroj: Arch Gynecol Obstet
Informace o vydavateli: Springer Science and Business Media LLC, 2023.
Rok vydání: 2023
Témata: Adult, Cesarean Section, Infant, Newborn [MeSH], Delivery, Obstetric/methods [MeSH], Female [MeSH], Delivery mode, Adult [MeSH], Obstetric management, Humans [MeSH], Retrospective Studies [MeSH], Pregnancy, Twin [MeSH], Predictive factors, Pregnancy Outcome/epidemiology [MeSH], Neonatal outcome, Twin pregnancy, Parity [MeSH], Infant [MeSH], Maternal-Fetal Medicine, Cesarean Section [MeSH], Pregnancy [MeSH], Infant, Newborn, Pregnancy Outcome, Infant, Delivery, Obstetric, 3. Good health, Parity, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Pregnancy, Twin, Humans, Female, Retrospective Studies
Popis: Purpose While the optimal delivery method of twin pregnancies is debated, the rate of cesarean deliveries is increasing. This retrospective study evaluates delivery methods and neonatal outcome of twin pregnancies during two time periods and aims to identify predictive factors for the delivery outcome. Methods 553 twin pregnancies were identified in the institutional database of the University Women’s Hospital Freiburg, Germany. 230 and 323 deliveries occurred in period I (2009–2014) and period II (2015–2021), respectively. Cesarean births due to non-vertex position of the first fetus were excluded. In period II, the management of twin pregnancies was reviewed; adjusted and systematic training with standardized procedures was implemented. Results Period II showed significantly lower rates of planned cesarean deliveries (44.0% vs. 63.5%, p p = 0.02). Independent risk factors for primary cesarean delivery were period I, maternal age > 40 years, nulliparity, a history with a previous cesarean, gestational age 20%). Predictive factors for successful vaginal delivery were previous vaginal delivery gestational age between 34 and 36 weeks and vertex/vertex presentation of the fetuses. The neonatal outcomes of period I and II were not significantly different, but planned cesareans in general were associated with increased admission rates to the neonatal intensive care units. Inter-twin interval had no significant impact on neonatal outcome. Conclusion Structured regular training of obstetrical procedures may significantly reduce high cesarean rates and increase the benefit–risk ratio of vaginal deliveries.
Druh dokumentu: Article
Other literature type
Popis souboru: pdf
Jazyk: English
ISSN: 1432-0711
DOI: 10.1007/s00404-023-07040-6
Přístupová URL adresa: https://pubmed.ncbi.nlm.nih.gov/37115274
https://repository.publisso.de/resource/frl:6523398
Rights: CC BY
URL: http://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (http://creativecommons.org/licenses/by/4.0/) .
Přístupové číslo: edsair.doi.dedup.....177ba6290fdba9c44c1a38b84d52d775
Databáze: OpenAIRE
Popis
Abstrakt:Purpose While the optimal delivery method of twin pregnancies is debated, the rate of cesarean deliveries is increasing. This retrospective study evaluates delivery methods and neonatal outcome of twin pregnancies during two time periods and aims to identify predictive factors for the delivery outcome. Methods 553 twin pregnancies were identified in the institutional database of the University Women’s Hospital Freiburg, Germany. 230 and 323 deliveries occurred in period I (2009–2014) and period II (2015–2021), respectively. Cesarean births due to non-vertex position of the first fetus were excluded. In period II, the management of twin pregnancies was reviewed; adjusted and systematic training with standardized procedures was implemented. Results Period II showed significantly lower rates of planned cesarean deliveries (44.0% vs. 63.5%, p p = 0.02). Independent risk factors for primary cesarean delivery were period I, maternal age > 40 years, nulliparity, a history with a previous cesarean, gestational age 20%). Predictive factors for successful vaginal delivery were previous vaginal delivery gestational age between 34 and 36 weeks and vertex/vertex presentation of the fetuses. The neonatal outcomes of period I and II were not significantly different, but planned cesareans in general were associated with increased admission rates to the neonatal intensive care units. Inter-twin interval had no significant impact on neonatal outcome. Conclusion Structured regular training of obstetrical procedures may significantly reduce high cesarean rates and increase the benefit–risk ratio of vaginal deliveries.
ISSN:14320711
DOI:10.1007/s00404-023-07040-6