Poster Session 1
Category: Clinical Obstetrics
Poster Session 1
Hiba J. Mustafa, MD (she/her/hers)
Director of Fetal Surgery, Director of Placenta Accreta Spectrum Program
Indiana University School of Medicine, Riley Children's Hospital
Indianapolis, Indiana, United States
Jana Karam, MD
Lebanese American University School of Medicine
Beirut, Beyrouth, Lebanon
Kevin Moss
Indiana University
Indianapolis, Indiana, United States
Cynthia Gyamfi-Bannerman, MD, MS (she/her/hers)
Professor and Chair
Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego
San Diego, California, United States
George R. Saade, MD
Department of Obstetrics and Gynecology, Eastern Virginia Medical School at Old Dominion University
Norfolk, Virginia, United States
.jpg "Alireza A. Shamshirsaz, MD (he/him/his) photo")
Alireza A. Shamshirsaz, MD (he/him/his)
Department Director, Professor of Surgery
Boston Children's Hospital, Harvard Medical School
Boston, Massachusetts, United States
To investigate the association between mode of delivery and neonatal outcomes in twin pregnancies delivered at 22–27+6 weeks’ gestation, focusing on survival by gestational age and neonatal active intervention
Study Design:
A cross-sectional, population-based cohort study was conducted using U.S. natality matched multiple birth and fetal death data from 2016–2020. Live-born twin pregnancies between 22 and 27+6 weeks were included. The primary exposure was mode of delivery (cesarean or vaginal); the primary outcome was in-hospital neonatal death. Secondary outcomes included need for ventilation, surfactant or antibiotic use, seizures, and NICU admission. Analyses were stratified by gestational age and conducted for the entire cohort and the subgroup receiving active postnatal interventions. Adjusted odds ratios (aOR) were estimated using multivariable logistic regression.
Results:
Among 9,036 twin pregnancies, cesarean delivery was associated with reduced odds of neonatal death compared to vaginal delivery at 22–24+6 weeks (aOR 0.35; 95% CI 0.19–0.69). When analysis was restricted to neonates who received active postnatal interventions (such as mechanical ventilation or surfactant), the overall mortality difference between modes of delivery was attenuated and not statistically significant (aOR 0.89; 95% CI 0.71–1.11). Importantly, within these actively treated neonates, a significant survival benefit for cesarean delivery remained only in those delivered at 24 to 24+6 weeks, with no significant difference observed at other gestational ages or beyond 25 weeks.
Conclusion:
Cesarean delivery is associated with significantly lower neonatal mortality for extremely preterm twins between 22 and 24 weeks, with a persistent benefit among actively treated infants only at 24 to 24+6 weeks. No mortality difference was observed for cesarean delivery beyond 25 weeks or in other actively treated gestational age groups. Counseling for periviable twin pregnancies should balance these nuanced findings with maternal risk and institutional context.