(580) Evaluating the Benefit of Obstetrical Interventions on Neonatal Survival in Periviable Twin Pregnancies

Evaluate the benefit of obstetrical interventions on neonatal survival in twin pregnancies at the threshold of viability.


Study Design:

This is a retrospective multi-center study of twin gestations delivered between 22 0/7 and 24 6/7 weeks gestation from January 2010 to July 2020 across 16 geographically distinct and diverse institutions. The primary objective was to assess the impact of obstetrical interventions on neonatal survival from delivery room.  Secondary outcomes included assessing maternal demographic characteristics and mode of delivery on survival. Statistical analysis employed independent t-tests for continuous variables, chi square for categorical variables and generalized linear models to explore intervention differences.


Results:

377 mothers met the inclusion criteria. Overall survival was 91.7% and was not impacted by maternal characteristics (age, parity, race/ethnicity, or insurance). Neonates who survived had a higher birth weight than those that died (595g ± 120 vs. 466g ± 113, p< 0.01). Obstetrics inventions including: antenatal corticosteroids (96% vs 83.2%, p< 0.01), magnesium sulfate (97.7% vs 83.6%, p< 0.01), tocolytic therapy (97.4% vs 88.8%, p< 0.01) and GBS prophylaxis (97.3% vs 88.2%, p< 0.01) demonstrated a significant increase in overall survival. Vaginal delivery was associated with increased survival compared to cesarean delivery (95.4% vs 88.7%, p=0.02). A stratified analysis of survival and obstetrical intervention by weeks of gestation is shown in Table 1. There was no difference in survival based on obstetrical intervention at 24wk.  Antenatal corticosteroids were associated with increased survival at 22wk.  Magnesium sulfate and tocolytic therapy were associated with increased survival at 23wk.


Conclusion:

Receipt of obstetrical interventions and vaginal delivery increased overall survival from delivery room for twin neonates born in the periviable period.