Prognosis for twins discordant in birth weight of 1.0 kg or more: The impact of cesarean section

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Abstract
The purpose of this population-based study on twins whose birth weight was discordant by 1.0 kg or more, was to evaluate the impact of abdominal delivery on the "corrected perinatal mortality" (fetal death prior to delivery being excluded), and also on childhood morbidity. Between 1973 and 1983, 277 such discordant twin pairs were identified in Sweden, using the Medical Birth Registry, Stockholm. The original medical records were retrieved for 267 pairs. The presence of childhood morbidity of 437 twins born between 1973 and 1980 was determined by means of questionnaires sent to rehabilitation centers for handicapped children, offices for the Provision of Care to the Mentally Retarded throughout Sweden, as well as to local Boards of Education. No association was found between corrected perinatal mortality figures and a more than 4-fold increase in cesarean section rate, from 11.4% during 1973-75 to 45.9% during 1980-83. The 10 perinatal deaths (1.9%) could be correlated with birth weight (9 small and 1 large twin; p = 0.01), but not to the mode of delivery of the smaller twins (6 born vaginally and 3 abdominally; p > 0.05). At follow-up, at the age of 8 years or more, 5 smaller and 4 larger twins had cerebral palsy and/or mental retardation; no correlation was found with mode of delivery. The results of this study show that perinatal deaths (twins with lethal malformation included) or residual major handicap occurred in one of ten pregnancies of twins with discordant birth weights. Abdominal delivery seemed to have little impact on either short or long-term outcome.