Study finds planned C-sections provide no advantage over planned vaginal birth of twins

2013-02-11

(Press-News.org) In a study to be presented on February 14 between 8 a.m., and 10 a.m. PST, at the Society for Maternal-Fetal Medicine's annual meeting, The Pregnancy Meeting ™, in San Francisco, researchers will report findings that suggest that planned birthing of twins at 32-38 weeks by cesarean section does not decrease perinatal or neonatal death compared to planned vaginal birth.

This randomized study The Twin Birth Study: a multicenter RCT of planned cesarean section and planned vaginal birth for twin pregnancies 320 to 386/7 weeks, should help women understand that a planned vaginal birth is as safe as a planned cesarean section as long as the first twin is situated head first.

"The results of the study show that vaginal birth is safe and should continue to be offered to women who are pregnant with twins," said Dr. Jon Barrett of Sunnybrook Health Science Centre, University of Toronto, Women and Babies Program, and one of the study's authors. "There's no evidence that a cesarean section is better for the babies or you."

Researchers studied more than 2800 women from 26 countries; and compared 1398 planned C-section births to 1406 planned vaginal births. Vaginal births were induced, and only twins 32-38 weeks—with the first twin situated head first—were eligible.

Their research reveals no advantage in choosing cesarean births in these types of twins. In fact, planned cesarean birth does not decrease—or increase—neither perinatal/neonatal death nor serious neonatal morbidity versus planned vaginal birth.

"My advice to a woman pregnant with twins is that she should attempt to find an OBGYN that is trained in vaginal birth, as there is no harm," said Barrett. ###

In addition to Barrett, the study was conducted by nine other doctors based in Canada: Elizabeth Aztalos and Mary Hannah of Sunnybrook Health Science Centre, University of Toronto, Women and Babies Program); B. Anthony Armson and Scott Farrell of Dalhousie University, Obstetrics & Gynecology in Halifax; Andy Willan (University of Toronto, Child Health Evaluative Sciences, Sickkids Research Institute), Ks Joseph (University of British Columbia, Obstetrics & Gynecology, Vancouver); Eileen Hutton (McMaster University, Faculty of Health Sciences, Hamilton); Alexander Allen (Dalhousie University, Paediatrics); Arne Ohlsson (Mt. Sinai Hospital, University of Toronto, Paediatrics); Sue Ross (University of Alberta, Obstetrics & Gynecology, Edmonton); Amiram Gafni (McMaster University, Clinical Epidemiology & Biostatistics) and Nan Okun (Mt. Sinai Hospital, University of Toronto, Obstetrics & Gynecology).

A copy of the abstract is available at http://www.smfmnewsroom.org/wp-content/uploads/2013/01/1-8.pdf and below. For interviews please contact Vicki Bendure at Vicki@bendurepr.com 202-374-9259 (cell), or Meghan Blackburn at Meghan@bendurepr.com, 540-687-5099 (office) or 859-492-6303 (cell).

The Society for Maternal-Fetal Medicine (est. 1977) is a non-profit membership group for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine. The society is devoted to reducing high-risk pregnancy complications by providing continuing education to its 2,000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. The group hosts an annual scientific meeting in which new ideas and research in the area of maternal-fetal medicine are unveiled and discussed. For more information, visit www.smfm.org or www.facebook.com/SocietyforMaternalFetalMedicine.

Abstract 7: The Twin Birth Study: a multicenter RCT of planned cesarean section(CS) and planned vaginal birth (VB) for twin pregnancies 320 to 386/7 weeks.

Jon Barrett1, Elizabeth Aztalos1, Andy Willan2, Ks Joseph5, B. Anthony Armson3, Eileen Hutton4, Alexander Allen8, Arne Ohlsson6, Sue Ross7, Scott Farrell3, Amiram Gafni9, Nan Okun10, Mary Hannah1

1Sunnybrook Health Science Centre, University of Toronto, Women and Babies Program, Toronto, ON, Canada; 2University of Toronto, Child Health Evaluative Sciences, Sickkids Research Institute, Toronto, ON, Canada; 3Dalhousie University, Obstetrics & Gynecology, Halifax, ON, Canada; 4McMaster University, Faculty of Health Sciences, Hamilton, ON, Canada; 5University of British Columbia, Obstetrics & Gynecology, Vancouver, BC, Canada; 6Mt. Sinai Hospital, University of Toronto, Paediatrics, Toronto, ON, Canada; 7University of Alberta, Obstetrics & Gynecology, Edmonton, AB, Canada; 8Dalhousie University, Paediatrics, Halifax, NS, Canada; 9McMaster University, Clinical Epidemiology & Biostatistics, Hamilton, ON, Canada; 10Mt. Sinai Hospital, University of Toronto, Obstetrics & Gynecology, Toronto, ON, Canada.

Objective: To compare planned CS with planned VB for twins 320/7 to 386/7 weeks, if the first twin is cephalic.

Study Design: Prospective RCT. Eligibility: Twins 32 to 38+6weeks, live fetuses, Twin A cephalic, EFW 1500g- 4000g. Exclusion: Fetal reduction at >13 wks gestation, lethal fetal anomaly, contraindication to labour. Delivery planned between 375/7 to 386/7 weeks by CS or inducing labour. Primary composite outcome: perinatal/neonatal mortality and/or serious neonatal morbidity. 2800 patients required to detect reduction of primary outcome from 4% to 2%. Power 80%, 2-sided, α error of 0.05. A logistic model was used with generalized estimating equations to account for correlation between babies from the same pregnancy

Results: 2804 women randomized from 26 countries. 1398 to planned CS vs.1406 to planned VB. There was no significant difference between treatment groups. Fifty seven babies of 2781(2.05%) experienced the primary outcome in planned CS vs.52 of 2782 (1.87%) in planned VB (OR1.098, CI 0.726 -1.663, p = 0.6569). There was no significant interaction between treatment group and parity, GA at randomization, mother's age, presentation of twin B, Chorionicity, and country's PNMR. Twin B more likely to experience the primary outcome (OR=1.895, CI: 1.329-2.703, p=0.0003). The interaction between treatment group and birth order was not significant (OR; A=1.239; OR;B=1.030, p=0.6125). 89 9% of the women who planned CS delivered both babies by CS. 60.45% in planned VB delivered at least twin A vaginally. 4% of women in planned VB group delivered twin B by CS following VB of twin A. Women in the planned CS delivered earlier but had no increase in maternal mortality or morbidity compared to planned VB.

Conclusion: Planned CS in twins at 32-38 week does not decrease (or increase) perinatal/neonatal death or serious neonatal morbidity vs planned VB when the first twin is cephalic.

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