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Perinatal outcomes in twin late preterm pregnancies: results from an Italian area-based, prospective cohort study.

Authors
  • Monari, Francesca1
  • Chiossi, Giuseppe2
  • Ballarini, Michela2
  • Menichini, Daniela3
  • Gargano, Giancarlo4
  • Coscia, Alessandra5
  • Baronciani, Dante6
  • Facchinetti, Fabio2
  • 1 Obstetrics and Gynecology Unit, Mother-Infant and Adult Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41125, Modena, Italy. [email protected] , (France)
  • 2 Obstetrics and Gynecology Unit, Mother-Infant and Adult Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41125, Modena, Italy. , (Italy)
  • 3 Department of Biomedical, Metabolic and Neural Sciences, International Doctorate School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41125, Modena, Italy. , (Italy)
  • 4 Department of Obstetrics and Pediatrics, Neonatal Intensive Care Unit, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, 42123, Reggio Emilia, Italy. , (Italy)
  • 5 Department of Public Health and Pediatrics, Neonatology Unit, Università degli Studi di Torino, 10126, Turin, Italy. , (Italy)
  • 6 Health Facilities, Technologies and Information Systems Unit, Emilia-Romagna Region, Viale Aldo Moro 21, 40127, Bologna, Italy. , (Italy)
Type
Published Article
Journal
Italian Journal of Pediatrics
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Jun 16, 2022
Volume
48
Issue
1
Pages
101–101
Identifiers
DOI: 10.1186/s13052-022-01297-4
PMID: 35710441
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Multiple gestations represent a considerable proportion of pregnancies delivering in the late preterm (LP) period. Only 30% of LP twins are due to spontaneous preterm labor and 70% are medically indicated; among this literature described that 16-50% of indicated LP twin deliveries are non-evidence based. As non-evidence-based delivery indications account for iatrogenic morbidity that could be prevented, the objective of our observational study is to investigate first neonatal outcomes of LP twin pregnancies according to gestational age at delivery, chorionicity and delivery indication, then non evidence-based delivery indications. Prospective cohort study among twins infants born between 34 + 0 and 36 + 6 weeks, in Emilia Romagna, Italy, during 2013-2015. The primary outcome was a composite of adverse perinatal outcomes. Among 346 LP twins, 84 (23.4%) were monochorionic and 262 (75.7%) were dichorionic; spontaneous preterm labor accounted for 85 (24.6%) deliveries, preterm prelabor rupture of membranes for 66 (19.1%), evidence based indicated deliveries were 117 (33.8%), while non-evidence-based indications were 78 (22.5%). When compared to spontaneous preterm labor or preterm prelabor rupture of membranes, pregnancies delivered due to maternal and/or fetal indications were associated with higher maternal age (p < 0.01), higher gestational age at delivery (p < 0.01), Caucasian race (p 0.04), ART use (p < 0.01), gestational diabetes (p < 0.01), vaginal bleeding (p < 0.01), antenatal corticosteroids (p < 0.01), diagnosis of fetal growth restriction (FGR) (p < 0.01), and monochorionic (p < 0.01). Two hundred twenty-six pregnancies (65.3%) had at least one fetus experiencing one composite of adverse perinatal outcome. Multivariate analysis confirmed that delivery indication did not affect the composite of adverse perinatal outcomes; the only characteristic that affect the outcome after controlling for confounding was gestational age at delivery (p < 0.01). Moreover, there was at least one adverse neonatal outcome for 94% of babies born at 34 weeks, for 73% of those born at 35 weeks and for 46% of those born at 36 weeks (p < 0.01). Our study suggests that the decision to deliver or not twins in LP period should consider gestational age at delivery as the main determinant infants' prognosis. Delivery indications should be accurately considered, to avoid iatrogenic early birth responsible of preventable complications. © 2022. The Author(s).

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