Neonatal Outcomes in Twin Pregnancies

Study Overview
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Brief Summary
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Multiple pregnancies are associated with increased maternal and fetal risks compared to singleton pregnancies. Additionally, the cesarean section rate is quite high in multiple pregnancies. This study aimed to evaluate maternal and fetal characteristics and factors affecting fetal outcomes in twin pregnancies delivered by cesarean section.

Detailed Description
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While the frequency of multiple pregnancies varies significantly among societies and individuals, especially in middle and high-income countries, the rate of multiple pregnancies has shown a significant rise worldwide in recent years, with the frequent use of assisted reproductive techniques, which has increased due to an increase in maternal age and a decrease in fertility. As a result, multiple pregnancies constitute approximately 2-4% of all births. Multiple pregnancies are known to be associated with increased maternal and fetal risks compared to singleton pregnancies. While maternal mortality associated with a twin pregnancy is 2.5 times higher than in singleton pregnancy, adverse neonatal outcomes such as perinatal mortality, fetal growth restriction, and low birth weight are two to three times higher in twins than in singleton newborns. Moreover, neonatal near-miss, which refers to cases that almost resulted in death, is associated with multiple pregnancies. For all these reasons, the planned cesarean section has been advocated over planned vaginal delivery to reduce the risk of adverse neonatal outcomes (especially for the second-born twin). However, cesarean delivery is known to be associated with a higher risk of maternal morbidity and poor neonatal outcomes. The vast majority of these risks are related to maternal hypotension, prolonged uterine-incision-to-delivery time, and general anesthesia. From this perspective, we aimed to evaluate maternal and fetal characteristics and factors affecting fetal outcomes in twin pregnancies delivered by cesarean section.

Official Title
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Factors Influencing the Neonatal Outcomes in Twin Pregnancies Undergoing Cesarean Section: a Cross-sectional Study

Conditions
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Neonate, Twin Pregnancy

Intervention / Treatment
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* Procedure: Spinal anesthesia
* Procedure: General anesthesia


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Twin pregnancies Parturients delivered by cesarean section Exclusion Criteria: The triplets or more multiple pregnancies Twins delivered through the vaginal route were excluded from the study.
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Twin neonates<br>The demographic data and characteristics of the twins were evaluated. | Procedure: Spinal anesthesia<br>* Twins delivered under under spinal anesthesia<br>Procedure: General anesthesia<br>* Twins delivered under general anesthesia<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| APGAR-1 | Appearance-Pulse-Grimace-Activity-Respiration (APGAR) score at the 1st minute after delivery | 1 minute | 
| APGAR-5 | Appearance-Pulse-Grimace-Activity-Respiration (APGAR) score at the 5th minute after delivery | 5 minute | 
| Neonatal Intensive Care Unit | Admission to Neonatal Intensive Care Unit after delivery | 1 hour | 
| Mechanical ventilation | The need for non-invasive and invasive mechanical ventilation | 28 days | 
| Death | Neonatal mortality within the first 28 days after birth. | 28 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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General anesthesia, Neonate, Obstetric anesthesia, Pregnancy Outcomes, Spinal anesthesia, Twins, Twin pregnancy