American journal of obstetrics and gynecology · 2005
The influence of mode of delivery on twin neonatal mortality in the US: variance by birth weight discordance.
СтатьяПоддержка службы здравоохранения СШАНазвание и аннотация: Перевод в очереди
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Kontopoulos Eftichia V, Ananth Cande V, Smulian John C, Vintzileos Anthony M
Аннотация
OBJECTIVE: 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.
STUDY DESIGN: 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.
RESULTS: 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 > or =40%; VV pairs had a 1.6-fold (95% CI 1.1-2.2) increased NMR compared with CC.
CONCLUSION: 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.
STUDY DESIGN: 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.
RESULTS: 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 > or =40%; VV pairs had a 1.6-fold (95% CI 1.1-2.2) increased NMR compared with CC.
CONCLUSION: 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.