Cesarean Delivery for the Second Twin in the Vertex-Vertex Presentation

Sullivan, Christopher A.; Harkins, Doug; Seago, D.Paul; Roberts, William S.; Morrison, J C

doi:10.1097/00007611-199802000-00007

Cited by 19 publications

(17 citation statements)

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“…15,16 Only one previous study has examined the mode of delivery for secondborn twin with vertex-vertex presentation. 22 The rate of cesarean delivery for the second twin after vaginal delivery of the first twin in that study was 16.9%, 22 which was much higher than the rate observed in our study (6.1%). The study by Sullivan et al 22 was based on a single obstetric care center with a very small sample (106 twin sets).…”

Section: Discussioncontrasting

confidence: 64%

“…22 The rate of cesarean delivery for the second twin after vaginal delivery of the first twin in that study was 16.9%, 22 which was much higher than the rate observed in our study (6.1%). The study by Sullivan et al 22 was based on a single obstetric care center with a very small sample (106 twin sets). The rates of emergency cesarean delivery for the second twin after vaginal delivery of the first twin were 11.3% in birth weight <1500 g, 5.8% in birth weight 1500-2499 g, and 5.7% in birth weight X2500 g in our study, which indicate that physicians may have a lower threshold to perform an emergency cesarean section for the second-born twin when the fetus was likely to be <1500 g. As a result, the rate of cesarean delivery for the second twin after vaginal delivery of the first twin was higher in this group of infants than those with a birth weight X1500 g. Our study found that in second twins with birth weight <1500 g, the risks of noncongenital anomaly-related neonatal death, and low Apgar score were increased in all second twins after a Odds ratios (95% confidence interval) were adjusted for maternal age, race, marital status, cigarette smoking during pregnancy, parity, medical complications (diabetes, pregnancyassociated hypertension, and abnormal labor), abnormality during delivery (precipitous labor, prolonged labor, dysfunctional labor, cephalopelvic disproportion, cord prolapse, and fetal distress), fetal gender and gestational age (24-35 weeks and X36 weeks).…”

Section: Discussioncontrasting

confidence: 64%

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Neonatal mortality and morbidity in vertex–vertex second twins according to mode of delivery and birth weight

et al. 2005

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Objective: To assess the risk of neonatal mortality and morbidity in vertex-vertex second twins according to mode of delivery and birth weight.Study design: Data from a historical cohort study based on a twin registry in the US (1995)(1996)(1997) were used. Multivariate logistic regression was used to control for maternal age, race, marital status, cigarette smoking during pregnancy, parity, medical complications, gestational age, and other confounders.Results: A total of 86 041 vertex-vertex second twins were classified into two groups: second twins delivered by cesarean section after cesarean delivery of first twin (C-C) (43.0%), second twins whose co-twins delivered vaginally (V-X) (57.0%). In infants of birth weight X2500 g group, the risks of noncongenital anomaly-related death (adjusted odds ratio (aOR): 4.64, 95% confidence interval (95% CI): 1.90, 13.92), low Apgar score (aOR: 2.39, 95% CI: 1.43, 4.14), and ventilation use (aOR: 1.31, 95% CI: 1.18, 1.47) were higher in the V-X group compared with the C-C group. No asphyxia-related neonatal deaths occurred in C-C group, whereas the incidence of this death was 0.04% in the V-X group. Conclusion:The risks of neonatal mortality and morbidity are increased in vertex-vertex second twins with birth weight X2500 g whose co-twins delivered vaginally compared with second twins delivered by cesarean section after cesarean delivery of first twin.

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Section: Discussioncontrasting

confidence: 64%

Section: Discussioncontrasting

confidence: 64%

Neonatal mortality and morbidity in vertex–vertex second twins according to mode of delivery and birth weight

et al. 2005

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“…The prevalence of cesarean delivery in this study was 12.09% (10.12% in induced cases versus 13.92% in none induced cases (OR 0, 7; 95% IC 0, 27-1, 85; P ≤ 0.50). Similar findings have been reported [44][45][46][47].…”

Section: Discussionsupporting

confidence: 91%

“…There were 23 cases of post partum hemorrhage due to uterine atony, 10 in the group of women who were induced and 13 in the second group but the difference was not statistically significant (OR 0.74; 95% IC 0.3 -1.8; P ≤ 0.50) similar to reports of similar studies [46,47]. There were no cases of uterine rupture.…”

Section: Discussionsupporting

confidence: 69%

Twin gestation: Is induction of labor possible in highly selected cases?

Mbu¹,

Fouedjio²,

Fouelifack³

et al. 2012

OJOG

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Induction of labor has been in practice for several decades but the decision to induce labor in multifetal gestations has not been accepted by many practitioners in contemporary obstetrics. The aim of this study was to compare maternal and fetal outcomes among women with uncomplicated twin gestations who were induced at term and those who were not. It was a cross-sectional analytic study that lasted ten years, (1 st January 2000 to 31 st December 2009 inclusive) at the maternity of the central hospital, Yaounde, Cameroon. 158 women were enrolled, 79 were induced and 79 went into labor spontaneously. Maternal and fetal outcomes, duration of labor, the prevalence of caesarean section were compared in the two groups. The average age of the women in the groups was 26, 75 ± 3.65 years (range 15 -41 years). For those who were induced, indication was premature rupture of membranes in 44 (56%) of cases. The characteristics of induced and none induced women were similar, except for the number of antenatal consultations (P ≤ 0.001). There was a significant difference in the duration of labor in the two groups (6 hrs versus 9, 75 hrs; P ≤ 0.001). The overall rate of vaginal delivery in the two groups was 87, 97% (n = 139), 88.87% in the group that was induced versus 86.07% in the group that labor was spontaneous (OR 1, 22; 95% IC 0, 51-2, 92; P ≤ 0.90). With respect to primary outcomes, there were no statistically significant differences between the group that labor was induced and that which labor was spontaneous. The prevalence of caesarean delivery was similar in the two groups (10%, 12% vs 13%, 92%; OR 0%, 7%; 95% IC 0, 27-1, 85; P ≤ 0.50). The main indications for caesarean section were acute fetal distress and failed induction. The first and fifth minute APGAR scores less than 7 in the first twins delivered in the two groups were similar. The 312 children delivered in both arms did not show any complications at birth. However, there were 3 neonatal deaths (1 vs 2). There were no cases of uterine rupture or maternal deaths among the 156 women. Induction of labor may be proposed to women with uncomplicated term twin gestations with specific indications. Induction in these highly selected cases does not impute any additional risks but close monitoring of labor is very necessary.

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“…Olofsson and Rhydstrom (14) reported an increase in the number of second twins being born abdominally, from 0.3% of all deliveries in 1973 to 7% by 1984, and in 1998 Sullivan et al . (6) reported a rate of 17% at their institution. Both studies speculate that declining obstetric skills and experience are responsible for the increased rates of cesarean section for twin B.…”

Section: Discussionmentioning

confidence: 99%