Neonatal and maternal outcomes in twin gestations ≥32 weeks according to the planned mode of delivery (original) (raw)
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Journal of Obstetrics & Gynaecology, 2012
To assess neonatal and maternal morbidity in twins ≥ 32 weeks ' gestation, related to the changes in planned mode of delivery, a retrospective cohort study was performed, including 185 twin births delivered in the Atrium Medical Centre, Heerlen, during the years 2003 -2008. The results were compared with those of an earlier study from our department during the period 1999 -2002. Compared with the 1999 -2002 cohort, the elective caesarean section rate signifi cantly increased from 17.7% to 36.8%. The secondary caesarean rate signifi cantly decreased from 15.9% to 8.8%, but increased from 1.2% to 3.3% for only twin B. No signifi cant diff erences in serious neonatal morbidity rates for twins A and B were found between both study periods, neither in the elective caesarean group, nor in the planned vaginal birth group. Serious maternal morbidity was not signifi cantly increased in both groups compared with the 1999 -2002 cohort.
Cesarean Section for the Second Twin: A Population-Based Study of Occurrence and Outcome
Birth, 2013
Background: Although management of twin deliveries has been a topic of discussion for decades, a consensus on how to deliver twins is lacking. The objective of this study was to examine short-term neonatal outcome of the second twin delivered by cesarean section after vaginal delivery of the first-born twin (combined delivery) and to identify predictors of combined delivery. Methods: This study was a 3-year, population-based, retrospective cohort investigation of 1,254 twin births in Denmark. The twin births were divided into three groups: vaginal deliveries, planned cesarean deliveries, and combined deliveries. Data were extracted from medical records, a fetal medicine software program (Astraia), and the National Birth Registry. Short-term poor neonatal outcome was measured as a 5-minute Apgar score 7, umbilical cord pH 7.10, and admission to neonatal intensive care unit for more than 3 days. Results: Vertex-nonvertex fetal presentations were more prevalent in combined deliveries than vaginal deliveries (OR 4.4, 2.5-7.8). Nonvertex second twins born by combined delivery had a higher risk of Apgar score 7 and umbilical cord pH 7.10 compared with vaginal delivery, unadjusted OR 6.2 (2.1-18), and unadjusted OR 3.9 (1.6-9.5). Prenatal ultrasound scans were evaluated in combined deliveries, of which 48 percent were vertex-vertex at the last ultrasound scan in pregnancy (mean gestational age 34 + 0) and 37 percent were vertex-vertex at birth. Conclusions: Vertex-nonvertex presenting twins have an increased risk of combined delivery. Combined deliveries are associated with increased neonatal morbidity for the second twin. (BIRTH 40:1 March 2013) Management of twin deliveries has been a topic of discussion for decades, yet the lack of randomized trials on the subject still leaves unanswered the question concerning optimal mode of twin delivery. In Denmark, there is a consensus that vaginal delivery may be attempted in women with cephalic presenting twins of similar size, no contraindications to trial of labor, and no intrauterine growth restriction of one or both twins. However, controversy on mode of delivery still remains when the second twin presents as nonvertex.
Clinical indicators associated with the mode of twin delivery: an analysis of 22,712 twin pairs
European journal of obstetrics, gynecology, and reproductive biology, 2015
To identify clinical indicators associated with the planned and actual mode of delivery in women with a twin pregnancy. We performed a retrospective cohort study in women with a twin pregnancy who delivered at a gestational age of 32+0-41+0 weeks and days between 2000 and 2008 in the Netherlands. Data were obtained from a nationwide database. We identified maternal, pregnancy-related, fetal, neonatal and hospital-related indicators that were associated with planned cesarean section (CS) and, for women with planned vaginal delivery (VD), for intrapartum CS. The associations between indicators and mode of delivery were studied with uni- and multivariate logistic regression analyses. We included 22,712 women with a twin pregnancy, of whom 4,310 women (19.0%) had a planned CS. Of the 18,402 women who had a planned VD, 14,034 (76.3%) delivered vaginally, 3,545 (19.3%) had an intrapartum CS, while 823 (4.5%) delivered twin A vaginally and twin B by intrapartum CS. The clinical indicators ...
Cesarean Delivery for the Second Twin
Obstetrics & Gynecology, 2008
Objective-To examine maternal and infant outcomes after a vaginal delivery of twin A and a cesarean delivery of twin B, and to identify whether the second twin experienced increased shortterm morbidity as part of a combined route of delivery.
The Australian & New Zealand journal of obstetrics & gynaecology, 2018
To examine the association between inter-twin delivery interval and short-term perinatal outcomes of the second twin after vaginal delivery of the first twin. Retrospective cohort study including twin pregnancies with a vaginal delivery of the first twin between January 2011 and September 2017 in a tertiary hospital in Melbourne, Australia. The main outcome measure was a composite of adverse neonatal outcome (at least one of perinatal death, admission to neonatal intensive care unit (NICU), endotracheal intubation, Apgar <7 at five minutes and cord lactate >4.0 mmol/L). Proportions of adverse outcomes for the second twin were compared between groups of intervals ≤ or >10 and ≤ or >30 min. The composite adverse neonatal outcome occurred in 201 (58.2%) and a caesarean section occurred in seven cases (2%) of the 345 pregnancies included. Delivery interval was associated with higher cord lactate. Low Apgar scores were more frequent with intervals >30 min (17.9% vs 6.6%, P...