Large for gestational age presenting twin: Risk factors, maternal and perinatal outcomes

Abstract

Objective: In singleton pregnancies, delivery of large for gestational age (LGA) newborn is associated with various adverse maternal and neonatal outcomes, yet data regarding LGA in twin pregnancies is scarce. We aimed at evaluating maternal and neonatal outcomes associated with LGA presenting twin.

Study design: A multicenter retrospective computerized database study in two university-affiliated obstetrical centers, between 2005 and 2021. Parturients with di-amniotic twin pregnancy who had a trial of vaginal delivery were included. Maternal and neonatal outcomes of parturients with LGA presenting twin were compared to parturients with non-LGA presenting twin.

Results: During the study period, 2,491 parturients with twin pregnancies were found eligible, of those 287 (11.5%) had LGA presenting twin. Parturients with LGA presenting twin were of higher gravidity and parity, had higher rates of previous cesarean deliveries and diabetes (pre-gestational & gestational). Mode of delivery of both presenting and second twin did not differ between the study groups. Maternal outcomes were comparable, specifically, rates of shoulder dystocia, and postpartum hemorrhage did not differ. Neonatal outcomes did not differ significantly between the groups other than a single case of clavicular fracture and a single case of encephalopathy in the group of LGA presenting twin.

Conclusion: In our study, delivery of LGA presenting twin was found safe to both, mother and neonate. Our findings provide reassurance regarding the safety of vaginal labor in this specific population and should be presented during counseling prior to twins' delivery.

Keywords: Adverse outcomes; Di-chorionic twins; Large for gestational age; Vaginal delivery.