TY - JOUR
T1 - The influence of mode of delivery on twin neonatal mortality in the US
T2 - Variance by birth weight discordance
AU - Kontopoulos, Eftichia V.
AU - Ananth, Cande V.
AU - Smulian, John C.
AU - Vintzileos, Anthony M.
PY - 2005/1
Y1 - 2005/1
N2 - The purpose of this study was to examine if neonatal mortality rates (NMR) based on birth weight discordance (BWD) differ based on mode of delivery. The population-based US "matched multiple birth" database (1995 to 1998) was used to examine the effect of vaginal/vaginal (VV) and cesarean/cesarean (CC) modes of delivery (MOD) on neonatal mortality (<28 days after birth). Births at <32 weeks, congenital malformations, chromosomal anomalies, and discordant MOD (vaginal/cesarean) were excluded. The association between MOD (with CC as the reference) and neonatal mortality was expressed as relative risks (RR) with 95% CI, derived from logistic regression models. The NMR increased with increasing degrees of BWD regardless of mode of delivery. CC was associated with decreased NMR when BWD was between 20% and 40%, but this reached significance at BWD ≥40%; VV pairs had a 1.6-fold (95% CI 1.1-2.2) increased NMR compared with CC. In twins with BWD <40%, MOD has no effect on NMR. Beyond or equal to 40% discordance, there was lower NMR with cesarean-cesarean delivery.
AB - The purpose of this study was to examine if neonatal mortality rates (NMR) based on birth weight discordance (BWD) differ based on mode of delivery. The population-based US "matched multiple birth" database (1995 to 1998) was used to examine the effect of vaginal/vaginal (VV) and cesarean/cesarean (CC) modes of delivery (MOD) on neonatal mortality (<28 days after birth). Births at <32 weeks, congenital malformations, chromosomal anomalies, and discordant MOD (vaginal/cesarean) were excluded. The association between MOD (with CC as the reference) and neonatal mortality was expressed as relative risks (RR) with 95% CI, derived from logistic regression models. The NMR increased with increasing degrees of BWD regardless of mode of delivery. CC was associated with decreased NMR when BWD was between 20% and 40%, but this reached significance at BWD ≥40%; VV pairs had a 1.6-fold (95% CI 1.1-2.2) increased NMR compared with CC. In twins with BWD <40%, MOD has no effect on NMR. Beyond or equal to 40% discordance, there was lower NMR with cesarean-cesarean delivery.
KW - Birth weight discordance
KW - Fetal presentation
KW - Mode of delivery
KW - Neonatal mortality
KW - Twin gestations
UR - http://www.scopus.com/inward/record.url?scp=12844274556&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=12844274556&partnerID=8YFLogxK
U2 - 10.1016/j.ajog.2004.05.056
DO - 10.1016/j.ajog.2004.05.056
M3 - Article
C2 - 15672033
AN - SCOPUS:12844274556
VL - 192
SP - 252
EP - 256
JO - American Journal of Obstetrics and Gynecology
JF - American Journal of Obstetrics and Gynecology
SN - 0002-9378
IS - 1
ER -
