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

Abstract

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.

Perinatal Outcome of the Second Twin at a Tertiary Care Center in India

“…It can be concluded that the mode of delivery is a significant predictor of perinatal outcome. However, whether it is the presentation or the mode of delivery that affects the perinatal outcome is not quite conclusive, as conflicting reports are available in the literature [28,29].…”

Should all term twin pregnancies be delivered by caesarean section?

“…The odds ratio for noncongenital anomaly related death of a second twin (> 2 500g) who was delivered vaginally was 2.72 (95% CI 1.09-8.24). 6 The rate of emergency caesarean section after vaginal delivery of the first twin was 6%. The odds ratio for death of the second twin in this group was 30.29 (95% CI 11.22-95.31).…”

“…13 If vaginal delivery is attempted, between 6-9% of second twins will be born by emergency caesarean section after vaginal delivery of the first twin. 6,14 Clinicians in favour of planned caesarean sections argue that maternal mortality is 70% higher if caesarean delivery is performed intrapartum rather than as a planned procedure. 15 The improved safety of caesarean sections is largely due to the use of regional anaesthesia, prophylactic antibiotics, thromboprophylaxis, improved suture material and techniques for controlling haemorrhage.…”

Elective cesarean delivery: when is it justified?

“…In the current edition of the Journal of Perinatology, Yang et al 6 in their paper Neonatal mortality and morbidity in vertex-vertex second twins according to mode of delivery and birth weight report that neonatal outcomes are improved for the second twin when both neonates undergo cesarean birth as compared to vaginal delivery of the first twin. In a retrospective cohort study of vertex-vertex twins using linked birth certificate data from the United States, the authors found that among second twins <1500 g and >2500 g, the adjusted neonatal mortality was lower among those delivered via cesarean for both neonates.…”