Cesarean delivery of twins and neonatal respiratory disorders

OBJECTIVE: The objective of this study was to evaluate the risk of neonatal respiratory disorders when cesarean delivery is performed before labor in twin pregnancies. STUDY DESIGN: We reviewed the charts of all patients with twin pregnancies who underwent cesarean delivery before labor after 36 weeks' gestation. Ail cases in which delivery was done for a clear maternal or fetal indication were excluded. Neonatal respiratory disorders included transient tachypnea of the newborn and respiratory distress syndrome. RESULTS: Delivery was performed between 36 weeks' and 37 weeks 6 days' gestation in 79 patients (62.7%) and between 38 weeks' and 40 weeks 2 days' gestation in 47 patients (37.3%). Respiratory disorders were diagnosed in 15 neonates from 11 pregnancies. Pregnancies in which one or both neonates were diagnosed with respiratory disorders were more likely to have been delivered before 38 weeks' gestation (90.9% vs 60.0%; P = .04) and were more likely to have been conceived spontaneously (54.5% vs 21.7%; P = .03) than those pregnancies with no affected neonates. CONCLUSIONS: Neonatal respiratory disorders are more common in twin pregnancies with cesarean delivery performed before labor before 38 weeks' gestation. Without a clear indication for delivery, waiting until labor or until after 38 weeks' gestation should be considered.