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' gest ation in 79 patients (62.7%) and between 38 weeks' and 40 weeks 2 days' ges tation in 47 patients (37.3%). Respiratory disorders were diagnosed in 15 n eonates from 11 pregnancies. Pregnancies in which one or both neonates were diagnosed with respiratory disorders were more likely to have been deliver ed before 38 weeks' gestation (90.9% vs 60.0%; P = .04) and were more likel y 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 pregnan cies with cesarean delivery performed before labor before 38 weeks' gestati on. Without a clear indication for delivery, waiting until labor or until a fter 38 weeks' gestation should be considered.