170: Timing of delivery in uncomplicated monochorionic-diamniotic twin pregnancies: comparison of neonatal outcomes at late preterm gestational ages

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Clinical Obstetrics, Medical-Surgical-Disease, Neonatology, Physiology-Endocrinology

170 Timing of delivery in uncomplicated monochorionicdiamniotic twin pregnancies: comparison of neonatal outcomes at late preterm gestational ages 1

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Poster Session I

171 Iatrogenic early term delivery and risk of adverse neonatal outcomes Jaclyn Coletta1, Kobina Ghartey1, Liza Lizarraga2, Elizabeth Murphy2, Cande Ananth1, Cynthia Gyamfi1

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Hen Sela , Alexandra Kass , Ananth Cande , David Bateman4, Joy-Sarah Vink1, Karin Fuchs5, Russell Miller5, Lynn Simpson6, Mary E. D’Alton5 1 Columbia University Medical Center, Obstetrics and Gynecology, Division of Maternal Fetal Medicine, New York, NY, 2Columbia University Medical Center, Department of Obstetrics and Gynecology Division of Maternal Fetal Medicine, New York, NY, 3Columbia University Medical Center, Obstetrics & Gynecology, New York, NY, 4Columbia University Medical Center, Pediatrics-Neonatology, New York, NY, 5 Columbia University Medical Center, Obstetrics and Gynecology, Division of Maternal Fetal Medicine, New York, NY, 6Columbia University Medical Center, Obstetrics and Gynecology, New York, NY

OBJECTIVE: The optimal time to deliver uncomplicated monochorionic-diamniotic (MCDA) twins remains uncertain. We compared neonatal outcomes of uncomplicated MCDA twins electively delivered at different late preterm gestational ages. STUDY DESIGN: A retrospective cohort study of all MCDA twins delivered at a single tertiary care center between 2003-10 was performed. Late preterm were defined as gestational ages of 340/7-356/7 weeks and uncomplicated MCDA twins were defined as concordantly grown twins without evidence of fetal growth restriction or growth discordance ⬎20%, normal anatomical surveys, no chromosomal abnormalities, normal amniotic fluid volumes and normal Dopplers of selected fetal vessels. Higher-order multiples, MCDA resulting from fetal reduction, cases of twin-twin transfusion syndrome, placental abruption, PPROM, and preeclampsia at ⬍32 weeks gestation were excluded. Planned delivery was defined as either elective induction or cesarean. Deliveries that were either spontaneous or indicated were considered non-planned (NP). Neonatal outcomes were compared between 34-35 weeks, 34-36 weeks and 35-36 weeks. All analyses were adjusted for the intracluster correlation due to twinning. RESULTS: During the study period, 134 of 482 MCDA twins (27.8%) meet inclusion/exclusion criteria. Forty-three (30%) pregnancies were delivered at 34 weeks, 33 (23%) delivered at 35 weeks and 58 (40%) delivered at ⱖ36 weeks. Results of performed comparisons are detailed in the table. CONCLUSION: During the study period, 134 of 482 MCDA twins (27.8%) were uncomplicated and delivered ⱖ34 weeks. Forty-three (30%) pregnancies were delivered at 34 weeks, 33 (23%) delivered at 35 weeks and 58 (40%) were delivered at ⱖ36 weeks. Results of performed comparisons are detailed in the table. There were very few difference in neonatal outcome between planned versus non-planned delivery at 34 weeks, 35 weeks, or 36 weeks. Compared to planned deliveries at 34 and 35 weeks, planned deliveries at 36 weeks were associated with better neonatal outcomes.

1 Columbia University Medical Center, Obstetrics and Gynecology, Division of Maternal Fetal Medicine, New York, NY, 2Columbia University Medical Center, Obstetrics and Gynecology, New York, NY

OBJECTIVE: Although considered full term, infants born between 37-38 weeks gestation are at increased risk for adverse outcomes compared to those delivered at ⱖ39 wks. Since delivery occurs at ⱖ37 weeks for a variety of indications, we sought to determine whether adverse neonatal outcomes after a spontaneous onset of labor at 37-38 weeks gestation were similar to adverse outcomes resulting from nonspontaneous labor. STUDY DESIGN: This is a retrospective cohort of singleton, non-anomalous early term (ET) deliveries (37 0/7 to 38 6/7 weeks gestation) from January to December 2010 at a single institution. Baseline maternal characteristics and neonatal outcomes were abstracted from medical records. Women presenting in spontaneous labor (via intact or ruptured membranes) and who went on to deliver vaginally or by cesarean were compared to those delivered for a non-spontaneous indication (via labor induction or scheduled cesarean). Our primary outcome was a composite neonatal morbidity adapted from a prior ET study –NICU admission, oxygen use, CPAP, ventilator support, respiratory distress syndrome, transient tachypnea of the newborn, hypoglycemia, sepsis, seizures, necrotizing enterocolitis, or hypoxic ischemic encephalopathy. RESULTS: 1,169 women delivered in the ET period; 712 (61%) presented in spontaneous labor and 457 (39%) were non-spontaneous. The groups were similar in maternal demographics, however the spontaneous group was older (38.0 wks versus 37.9 wks, p⬍0.001), and less likely to be exposed to steroids (2.1% versus 6.6%, p⬍0.001). In the univariate model, there was a significant decrease in the composite adverse outcome in neonates that were delivered spontaneously (Table). After adjusting for confounders, this finding held true (p⬍0.003). CONCLUSION: Neonates of women who labor spontaneously in the ET period are less likely to experience morbidity when compared with neonates from women from all non-spontaneous indications. The increased morbidity in the non-spontaneous group suggests careful consideration to the indication when electing to deliver a patient prior to 39 weeks.

Supplement to JANUARY 2012 American Journal of Obstetrics & Gynecology

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