Mode of delivery for vertex–nonvertex twin gestations

Usta, Ihab M.; Rechdan, Johnny B.; Khalil, Ali; Nassar, Anwar H.

doi:10.1016/j.ijgo.2004.09.013

Cited by 12 publications

(10 citation statements)

References 18 publications

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“…Eighteen articles were included in the meta‐analysis (Table 1). 8,10,11,17–31 Twelve articles 17,19–29 reported neonatal outcomes for both twins, of which all but four 19–21,25 described better outcomes for Twin A than Twin B. Overall, neonatal morbidity was lower in Twin A (1224 of 39 571; 3.0%) than Twin B (1842 of 39 571, 4.6%; Z = 4.34; P < 0.001; OR 0.53; 95% CI 0.39–0.70) (Figure 1A) (not reported in one article 28 ).…”

Section: Resultsmentioning

confidence: 97%

“…The outcomes for Twin B with regard to the actual mode of delivery were investigated in ten articles, 8,10,11,17,18,20,23,27,30,32 , of which five did not detect a significant difference of morbidity and mortality rate between vaginal delivery and caesarean section. When pooled, there were 127 472 of 250 118 (51%) vaginal deliveries and 122 646 of 250 118 (49%) caesarean sections.…”

Section: Resultsmentioning

confidence: 99%

“…Five articles could be pooled with regard to both presentation and mode of delivery, 8,18,20,30,32 , which collectively included 90 347 (85%) vertex and 16 022 (15%) nonvertex presentation of Twin B. Of the former, 50 168 (55%) were delivered vaginally and 40 179 (45%) by caesarean section.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Neonatal outcomes of twins according to birth order, presentation and mode of delivery: a systematic review and meta-analysis*

Rossi

Mullin

Chmait

2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

108

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Background The optimal mode of delivery for twins is undetermined.Objective To review literature regarding the neonatal outcomes following twin delivery.Data sources Searches were conducted in PubMed, Medline, Embase, Cochrane library and reference lists.Selection criteria Studies selection criteria were: both twins alive at labour, outcomes stratified for birth order, presentation, planned and actual delivery mode. Eighteen articles were included in the meta-analysis (39 571 twin sets). Data collection and analysisThe Meta-analysis of Observational Studies in Epidemiology guidelines were followed. Interstudy heterogeneity (I 2 ) was tested. A fixed model was generated whenever I 2 < 25%. Pooled odds ratios (OR) with 95% CI were computed. Intergroup comparison was significant if 95% CI did not encompass 1. The first and second twins were indicated as Twin A (TA) and Twin B (TB), respectively.Main results Neonatal morbidity was lower in TA than TB (3.0 versus 4.6%; OR 0.53; 95% CI 0.39-0.70). TA experienced neonatal death less often than TB (0.3 versus 0.6%; OR 0.55; 95% CI 0.38-0.81). No differences were noted between vertex and non-vertex and attempted vaginal delivery versus planned caesarean section in either TA or TB. In TA, neonatal morbidity was lower after vaginal delivery (1.1%) than caesarean section (2.2%; OR 0.47; 95% CI 0.27-0.82). Neonatal death was not associated with actual delivery mode. In TB, morbidity following combined delivery (19.8%) was higher than after vaginal delivery (9.5%; OR 0.55; 95% CI 0.41-0.74) or caesarean section (9.8%; OR 0.47; 95% CI 0.43-0.53). When outcomes were stratified for both presentation and delivery mode, mortality rate was lower after vaginal delivery than caesarean section for both vertex and nonvertex TB.Author's conclusion An attempt at vaginal delivery should be considered in twin pregnancies with vertex/vertex presentation.

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Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

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Neonatal outcomes of twins according to birth order, presentation and mode of delivery: a systematic review and meta-analysis*

Rossi

Mullin

Chmait

2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

108

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“…Apgar scores or perinatal mortality alone provide unsatisfactory means of defining birth asphyxia or predicting the neurologic outcome of newborns (15-17). Moreover, both breech extraction and intrapartum external version are potential confounding variables that clearly affect the clinical condition of newborns (1, 7, 18, 19). Therefore, we focused on the outcome of newborns based on fetal acid-base status as measured in umbilical arterial blood to provide objective evidence of peripartum asphyxial insult and subsequent neonatal outcome, and in addition, we selected twin pregnancies where both twins were delivered in the normal cephalic vaginal mode.…”

Section: Introductionmentioning

confidence: 99%

Relationship between Twin-to-twin Delivery Interval and Umbilical Artery Acid-base Status in the Second Twin

et al. 2007

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The purpose of this study was to determine the effect of twin-to-twin delivery interval on umbilical artery acid-base status of the second twin at birth. This was a retrospective cohort study of all live-born twins with measured acid-base status in umbilical arterial blood who were delivered after 34 weeks' gestation from June 2003 to February 2006. Twins with any maternal or fetal complications were excluded. Subjects were divided into two groups based on the mode of delivery of the first twin: normal cephalic vaginal deliveries (n=40) or cesarean deliveries (n=67). The inter-twin differences in umbilical arterial blood pH, PCO2, PO2, and base excess in twin newborns born vaginally were significantly greater than the corresponding differences in those born by cesarean section. A significant positive correlation was found between twin-to-twin delivery interval and inter-twin difference in umbilical arterial blood pH in twin newborns born vaginally. The umbilical arterial blood pH of the second twin was less than 7.0 in 14% (2/14) in cases delivered more than 20 min after the first twin. The umbilical arterial blood gas status of the second twin worsened with increasing twin-to-twin delivery interval, and pathologic fetal acidemia (pH < 7.0) might develop in the second twin when the twin-to-twin delivery interval was greater than 20 min.

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“…Pour certains auteurs, on ne note pas de diffé rences significatives de l'é tat de santé des nouveau-né s selon leur mode de naissance et leurs type de pré sentation [6,[11][12][13][14][15][16]19,20]. D'autres rapportent des diffé -rences en faveur de la cé sarienne, mais en faisant des groupes selon le type de pré sentation de J1 et surtout de J2, lorsque celui-ci n'est pas en pré sentation cé phalique [21][22][23]. Une mé ta-analyse de Hogle et al retrouvent un Apgar infé rieur à 7 à cinq minutes moins fré quent en cas de cé sarienne programmé e. Ce ré sultat est expliqué par le fait que l'Apgar est plus bas si J1 est en siè ge.…”

Section: Discussionunclassified

Présentations et modes d’accouchements de 371 grossesses gémellaires

Boukerrou

Robillard

Gérardin

et al. 2011

Gynécologie Obstétrique & Fertilité

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Mode of delivery for vertex–nonvertex twin gestations

Abstract: Vaginal delivery in vertex-nonvertex twins was achieved in 63.6% of cases at the expense of a higher incidence of low 1- and 5-min Apgar scores and neonatal death.

Cited by 12 publications

References 18 publications

Neonatal outcomes of twins according to birth order, presentation and mode of delivery: a systematic review and meta-analysis*

Neonatal outcomes of twins according to birth order, presentation and mode of delivery: a systematic review and meta-analysis*

Relationship between Twin-to-twin Delivery Interval and Umbilical Artery Acid-base Status in the Second Twin

Présentations et modes d’accouchements de 371 grossesses gémellaires

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