Perinatal outcomes in Finnish twins: a retrospective study

Second twin outcome at birth: retrospective analysis in a single tertiary centre in Malaysia

OBJECTIVES

To investigate factors associated with outcome of second twin during labour.

METHODS

The study was a retrospective cohort study in a single tertiary centre in Malaysia from 2014 until 2018 involving all twin pregnancies delivered at or more than 24 weeks of gestation.

RESULTS

Total of 409 twin pregnancies were included. Dichorionic twin comprises of 54.5 % (n=223) and 45.5 % (n=186) are monochorionic. Women with dichorionic pregnancies are significantly older (p<0.001), have more pre-existing medical disorders (p=0.011) and fetal structural anomalies (p=0.009). Monochorionic pregnancies are significantly more amongst Malay (p=0.01) and conceived spontaneously (p<0.001). There are significantly more fetuses both in cephalic presentation (p=0.026), birthweight discrepancy more than 20 % (p=0.038) and shorter mean inter-twin delivery duration (p=0.048) in monochorionic pregnancies. Second twin delivered with Apgar score <7 is significantly more in dichorionic pregnancies (p=0.006). The second twin is associated with lower birthweight, small for gestational age and arterial cord pH<7.25. Within the group of women who delivered both fetuses vaginally, there was significantly more second twins with intertwin delivery duration less than 30 min who were delivered vaginally without instrumentation (p=0.018). There was significantly more second twin with intertwin delivery duration of 30 min and more with arterial cord pH<7.25 (p=0.045). Those who delivered spontaneously had inter-twin delivery duration within 15-29 min. The outcome of second twin is not influenced by type of twin, gestational age at delivery, inter-twin delivery duration, mode of delivery and presentation at birth.

CONCLUSIONS

The neonatal outcome for the second twin at birth is not influenced by type of twin, gestational age at delivery, inter-twin delivery duration, mode of delivery and presentation at birth in a cohort managed with non-active management of the second twin in Malaysia.

The association between epidural labor analgesia and the fetal outcome and mode of delivery of the second twin: a nationwide register-based cohort study in Finland

BACKGROUND

The aim of this study was to assess the association between epidural labor analgesia and the mode of delivery for the second twin and to analyze the health outcomes of the second twin.

METHODS

In this nationwide, retrospective, register-based cohort study, data from the National Medical Birth Register (MBR) of Finland (2004-2018) were used to analyze the association between epidural analgesia and delivery mode (emergency and urgent cesarean section, and assisted vaginal delivery) and fetal outcomes (neonatal mortality and need for intensive care unit admission) for the second twin. Multivariable logistic regression was used to assess the delivery mode and fetal outcomes of the second twin.

RESULTS

A total of 3242 twin pregnancies with epidural analgesia were compared with a control group consisting of 2780 twin pregnancies without epidural analgesia. Epidural analgesia was associated with lower odds for all cesarean delivery (aOR 0.64, 95% CI 0.44 to 0.92) for the second twin and for emergency cesarean delivery (aOR 0.52, 95% CI 0.33 to 0.79) when compared with the odds for the second twin in the control group. Epidural analgesia was associated with lower odds of neonatal mortality for the second twin (aOR 0.61, 95% CI 0.73 to 0.90).

CONCLUSION

This study found epidural labor analgesia was associated with a lower rate of emergency cesarean delivery and neonatal mortality for the second twin. These results should be acknowledged by obstetricians and anesthesiologists when planning optimal peripartum management for mothers with twin pregnancies.

Trends in the use for labor analgesia in twin pregnancies: A nationwide register-based analysis in Finland

Objectives

The aim of this study is to calculate the trends in the use of labor analgesia in vaginal twin pregnancies at or after 37+0 weeks of gestation and evaluate the use of different labor analgesia in vaginal twin deliveries when compared to vaginal singleton pregnancies.

Study design

Data from the National Medical Birth Register during the years 2004-2018 was used to evaluate the usage of labor analgesia in vaginal twin deliveries at or after 37+0 weeks of gestation when compared to a comparison group consisting of singleton deliveries at or after 37+0 weeks of gestation. These results are presented as adjusted risk ratios (aORs) with 95% confidence intervals (Cis). The model was adjusted by maternal age and gestational diabetes, year of the pregnancy, and labor induction.

Results

A total of 3060 twin deliveries and 669 718 singleton deliveries (comparison group) were included in our study. The use of spinal analgesia in vaginal twin deliveries has shown a steadily growing trend increasing from 7.8% (95% Ci 4.8, 12.0) in 2004-24.8% (95% Ci 16.0, 33.0) in 2018. When compared to singleton deliveries, there was increased use of epidural analgesia (57.3% vs 46.1%, aOR 1.41; 95% Ci 1.31, 1.51), but lower use of spinal analgesia (12.3% vs 16.7%, aOR 0.66; 95% Ci 0.59, 0.73), another medical (7.9% vs 12.5%, aOR 0.55; 95% Ci 0.48, 0.63), and nonmedical analgesia (21.8% vs 30.2%, aOR 0.69, 95% Ci 0.63, 0.76) observed among women with twin pregnancies.

Conclusions

The main finding of this study was that women with twin pregnancies had a higher rate of epidural analgesia than women with singleton pregnancies. The results of this study should be acknowledged by midwives, obstetricians, and anesthesiologists to provide optimal pain relief for mothers with twin pregnancies and encourage researchers to further research on this topic.

Mode of delivery of Finnish dichorionic and monochorionic-diamniotic twins: A retrospective observational study including a risk score for intrapartum cesarean birth

Background and Aims

Trial of labor is considered safe also among twins, yet nearly 50% are born via cesarean section in Finland. While planned cesarean births have declined among twins, intrapartum cesarean deliveries have risen, postulating evaluation of criteria for trial of labor. The objective of this study was to create an outline of the mode of delivery of dichorionic and monochorionic-diamniotic Finnish twins. By evaluating risk factors for intrapartum cesarean delivery (CD), we aimed at creating a risk score for intrapartum cesarean birth for twins.

Methods

A retrospective observational study based on a cohort of dichorionic and monochorionic-diamniotic twin pregnancies considered as candidates for trial of labor in 2006, 2010, 2014, and 2018 (n = 720) was performed. Differences between parturients with vaginal delivery and intrapartum CD to identify potential risk factors for intrapartum CD were assessed. Logistic regression analysis (n = 707) was used to further define risk score points for recognized risk factors.

Results

A total of 23.8% (171/720, 95% confidence interval [CI] = 20.7-26.9) of parturients experienced intrapartum CD. Induction of labor, primiparity, fear of childbirth, artificial reproductive technology, higher maternal age, and other than cephalic/cephalic presentation independently associated with intrapartum CD. The achieved total risk score ranged from 0 to 13 points with significantly higher points among the CD group (6.61 vs. 4.42, p < 0.001). Using ≥8 points as a cut-off, 51.4% (56/109) were delivered by intrapartum CD (sensitivity = 33.73%, specificity = 90.20%, positive predictive value = 51.38%, negative predictive value = 81.61%). The total risk score had a fair predictive capability for intrapartum CD (area under the curve = 0.729, 95% CI = 0.685-0.773).

Conclusion

Fair-level risk stratification could be achieved with higher maternal age, primiparity, induction of labor, artificial reproductive technology, fear of childbirth, and other than cephalic/cephalic presentation increasing the risk. Parturients with low-risk score (0-7 points) appear to be the best candidates for trial of labor with acceptable CD rates in this group (18.4%).

Prediction of Neonatal Respiratory Morbidity Assessed by Quantitative Ultrasound Lung Texture Analysis in Twin Pregnancies

The objective of this study was to evaluate the performance of quantitative ultrasound of fetal lung texture analysis in predicting neonatal respiratory morbidity (NRM) in twin pregnancies. This was an ambispective study involving consecutive cases. Eligible cases included twin pregnancies between 27.0 and 38.6 weeks of gestation, for which an ultrasound image of the fetal thorax was obtained within 48 h of delivery. Images were analyzed using quantusFLM^® version 3.0. The primary outcome of this study was neonatal respiratory morbidity, defined as the occurrence of either transient tachypnea of the newborn or respiratory distress syndrome. The performance of quantusFLM^® in predicting NRM was analyzed by matching quantitative ultrasound analysis and clinical outcomes. This study included 166 images. Neonatal respiratory morbidity occurred in 12.7% of cases, and it was predicted by quantusFLM^® analysis with an overall sensitivity of 42.9%, specificity of 95.9%, positive predictive value of 60%, and negative predictive value of 92.1%. The accuracy was 89.2%, with a positive likelihood ratio of 10.4, and a negative likelihood ratio of 0.6. The results of this study demonstrate the good prediction capability of NRM in twin pregnancies using a non-invasive lung texture analysis software. The test showed an overall good performance with high specificity, negative predictive value, and accuracy.

Perinatal outcome of dichorionic and monochorionic-diamniotic Finnish twins: a historical cohort study

INTRODUCTION

Although the perinatal mortality of monochorionic twins has been reported to be higher, the role of chorionicity is debated and data from Finland are still lacking. To examine the effect of chorionicity on the main outcome measures, perinatal and neonatal mortality and neonatal morbidity of Finnish twins, a comprehensive population-based historical cohort study was performed at Helsinki University Hospitals.

MATERIAL AND METHODS

All 1034 dichorionic and monochorionic-diamniotic twin pregnancies managed at Helsinki University Hospital area during 2006, 2010, 2014 and 2018 were collected from patient databases. Information on chorionicity was retrieved from ultrasound reports and all relevant clinical information from patient records. Differences in perinatal and neonatal mortality and neonatal morbidity were analyzed by performing group comparisons between the twins and chorionicity. The role of chorionicity was also assessed in logistic regression analyses.

RESULTS

There were 1034 dichorionic-diamniotic (DCDA, n = 789, 76.3%, 95% confidence interval [CI] 73.6-78.9) and monochorionic-diamniotic (MCDA, n = 245, 23.7%, 95% CI 21.4-26.0) twin pregnancies during the studied years. Most (n = 580, 56.1%, 95% CI 52.8-59.2) twins were born at term, but 151 (61.6%, 95% CI 55.8-67.3) of MCDA twins were preterm and had lower birthweight and Apgar scores and higher risk of death of one twin. Perinatal and neonatal mortality did not differ between twins A and B, but the immediate outcome of twin B was worse, with lower arterial pH and Apgar scores and increased need of neonatal intensive care unit treatment.

CONCLUSIONS

Chorionicity contributes to the perinatal and neonatal outcome in favor of dichorionic twins. This disadvantage of MCDA twinning is likely explained by earlier gestational age at birth and inequal placental sharing. Irrespective of chorionicity, twin B faces more complications.

Micronutrients in Multiple Pregnancies-The Knowns and Unknowns: A Systematic Review

Maternal diet and nutritional status are of key importance with regard to the short- and long-term health outcomes of both the mother and the fetus. Multiple pregnancies are a special phenomenon in the context of nutrition. The presence of more than one fetus may lead to increased metabolic requirements and a faster depletion of maternal macro- and micro- nutrient reserves than in a singleton pregnancy. The aim of this systematic review was to gather available knowledge on the supply and needs of mothers with multiple pregnancies in terms of micronutrients and the epidemiology of deficiencies in that population. It was constructed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA). The authors conducted a systematic literature search with the use of three databases: PubMed/MEDLINE, Scopus and Embase. The last search was run on the 18 October 2020 and identified 1379 articles. Finally, 12 articles and 1 series of publications met the inclusion criteria. Based on the retrieved studies, it may be concluded that women with multiple pregnancies might be at risk of vitamin D and iron deficiencies. With regard to other microelements, the evidence is either inconsistent, scarce or absent. Further in-depth prospective and population studies are necessary to determine if nutritional recommendations addressed to pregnant women require adjustments in cases of multiple gestations.

Correction to: Perinatal outcomes in Finnish twins: a retrospective study

An amendment to this paper has been published and can be accessed via the original article.