Twin Birth Study: 2-year neurodevelopmental follow-up of the randomized trial of planned cesarean or planned vaginal delivery for twin pregnancy
| Autor: | Kathryn Mangoff, Eileen K. Hutton, Jon Barrett, J. Johanna Sanchez, Elizabeth Asztalos, Alexander C. Allen, Amiram Gafni, K.S. Joseph, Arne Ohlsson, B. Anthony Armson, Mary E. Hannah, Sue Ross, Andrew R. Willan |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
medicine.medical_specialty law.invention 03 medical and health sciences Young Adult 0302 clinical medicine Randomized controlled trial 030202 anesthesiology law Pregnancy 030225 pediatrics Infant Mortality medicine Humans Twin Pregnancy 030219 obstetrics & reproductive medicine Vaginal delivery Obstetrics business.industry Cesarean Section Cephalic presentation Parturition Obstetrics and Gynecology Infant Odds ratio medicine.disease Delivery Obstetric 3. Good health Neurodevelopmental Disorders Child Preschool Cohort Pregnancy Twin Gestation Female business Follow-Up Studies |
| Zdroj: | American journal of obstetrics and gynecology. 214(3) |
| ISSN: | 1097-6868 |
| Popis: | Background The Twin Birth Study randomized women with uncomplicated pregnancies, between 32 0/7 -38 6/7 weeks' gestation where the first twin was in cephalic presentation, to a policy of either a planned cesarean or planned vaginal delivery. The primary analysis showed that planned cesarean delivery did not increase or decrease the risk of fetal/neonatal death or serious neonatal morbidity as compared with planned vaginal delivery. Objective This study presents the secondary outcome of death or neurodevelopmental delay at 2 years of age. Study Design A total of 4603 children from the initial cohort of 5565 fetuses/infants (83%) contributed to the outcome of death or neurodevelopmental delay. Surviving children were screened using the Ages and Stages Questionnaire with abnormal scores validated by a clinical neurodevelopmental assessment. The effect of planned cesarean vs planned vaginal delivery on death or neurodevelopmental delay was quantified using a logistic model to control for stratification variables and using generalized estimating equations to account for the nonindependence of twin births. Results Baseline maternal, pregnancy, and infant characteristics were similar. Mean age at assessment was 26 months. There was no significant difference in the outcome of death or neurodevelopmental delay: 5.99% in the planned cesarean vs 5.83% in the planned vaginal delivery group (odds ratio, 1.04; 95% confidence interval, 0.77–1.41; P = .79). Conclusion A policy of planned cesarean delivery provides no benefit to children at 2 years of age compared with a policy of planned vaginal delivery in uncomplicated twin pregnancies between 32 0/7 -38 6/7 weeks' gestation where the first twin is in cephalic presentation. |
| Databáze: | OpenAIRE |
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