Risk factors for cesarean delivery and adverse neonatal outcome in twin pregnancies attempting vaginal delivery

Schachter-Safrai, Natali; Karavani, Gilad; Haj-Yahya, Rani; Shlomai, Noa Ofek; Porat, Shay

doi:10.1111/aogs.13333

Cited by 17 publications

(26 citation statements)

References 22 publications

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“…Further, we had the data about the fetal presentations at the time of admittance and were able to compare them with presentations at delivery, which is not often reported in retrospective studies. 14,[17][18][19]21 The fetal presentations remained relatively stable throughout the delivery, especially with the C/C group. The TOL rate was high in twin pregnancies of ≥35 +0 weeks of gestation, and the majority of those who attempted VD achieved it.…”

Section: Discussionmentioning

confidence: 89%

“…Of these, nulliparity showed the strongest relation to unsuccessful vaginal twin delivery, as has previously been reported. [17][18][19][20][21][22] Although a non-cephalic second twin was found to be an independent risk factor of CS, as many as 76.1% of the C/NC group cases achieved vaginal birth and perinatal outcomes were comparable in the C/C and C/NC groups. Therefore, in the light of these results, TOL can be a favorable option for twin pregnancies with a non-cephalic second twin if the parturient is oriented towards TOL.…”

Section: Discussionmentioning

confidence: 91%

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Risk factors of unsuccessful vaginal twin delivery

Ylilehto

Palomäki

Huhtala

et al. 2020

Acta Obstet Gynecol Scand

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Introduction: Twin trial of labor presents a challenge to obstetricians, as it is associated with a greater number of adverse birth outcomes compared with singleton deliveries. The risk of poor outcome has shown to be highest with unsuccessful vaginal twin delivery. The purpose of this study was to identify the clinical risk factors associated with intrapartum cesarean section in late preterm and term twin births. Material and methods: All live diamniotic twin deliveries of at least 35 +0 weeks of gestation with planned vaginal delivery were included in this retrospective singlecenter cohort study. Maternal and newborn characteristics were compared between a vaginal delivery group and an intrapartum cesarean section group. Logistic regression analysis was carried out to determine independent risk factors of intrapartum cesarean section. Further, maternal and neonatal outcomes were compared between groups of vaginal delivery and cesarean section for both twins and also between groups of vaginal delivery and cesarean section for the second twin only (combined delivery). The impact of presentation of the second twin on the mode of twin delivery and on neonatal outcome was also examined. Results: Among 821 twin pregnancies, 581 mothers (70.8%) attempted trial of labor and were eligible for the study. With a cephalic-presenting first twin, the trial of labor rate was 89.3% and vaginal delivery was successful in 82.8%. Nulliparity (odds ratio [OR] 3.2, 95% confidence interval [CI] 2.0-5.1) and non-cephalic presentation of the second twin (OR 3.0, 95% CI 1.9-4.8) were found to be independent risk factors of cesarean section. However, 76.1% of mothers with non-cephalic second twins achieved vaginal delivery and perinatal outcomes were comparable with cases of cephalic-presenting second twins. When comparing delivery modes, maternal outcomes were more favorable with vaginal delivery, whereas combined delivery increased the second twin's risk of adverse neonatal outcome. Conclusions: This study, with high rates of trial of labor and successful vaginal twin delivery, found nulliparity and non-cephalic presentation of the second twin to be risk factors of intrapartum cesarean section in twin pregnancies.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 91%

Risk factors of unsuccessful vaginal twin delivery

Ylilehto

Palomäki

Huhtala

et al. 2020

Acta Obstet Gynecol Scand

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“…Although 36–37 weeks' gestation may be a little early, they were selected to increase the possibility of planned delivery management. In this study, we examined the perinatal outcomes in the 1-day trial of vaginal delivery of twins to confirm the validity and safety of this approach for nulliparous and multiparous women separately since nulliparity is a recognized risk factor strongly associated with cesarean delivery of twin pregnancies [111213].…”

Section: Methodsmentioning

confidence: 99%

“…In this study, we examined maternal age, chorionicity, fetal presentation of the second twin, and fetal growth (birth weight) as additional potential risk factors of emergency cesarean delivery [111213]. As the secondary aims of this study, we examined indications for emergency cesarean section for both twins or the second twin, the expression of neonatal depression (defined by an Apgar score <7 at 1 minute), the presence of neonatal asphyxia (defined by an umbilical artery pH <7.0), and postpartum hemorrhage requiring transfusion.…”

Section: Methodsmentioning

confidence: 99%

Outcomes of ‘one-day trial of vaginal delivery of twins’ at 36–37 weeks' gestation in Japan

Haruna

Suzuki

2019

Obstet Gynecol Sci

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ObjectiveThe lack of obstetricians in Japan has prevented the implementation of a 24–hour delivery monitoring system for high-risk deliveries such as twin vaginal delivery at many obstetric facilities. To examine the outcomes of a 1-day trial of the vaginal delivery of twins at 36–37 weeks' gestation.MethodsWe induced the vaginal delivery of twins at 36–37 weeks' gestation of 256 women who provided consent between January 2007 and December 2016 using the following protocol: 1) administration of 0.5 mg oral prostaglandin E2 every 1 hour (maximum: 1.5 mg) in the morning; 2) intravenous administration of oxytocin and amniotomy in the afternoon; and 3) selection of caesarean delivery when vaginal delivery was not expected by evening. We examined their perinatal outcomes in a chart review.ResultsThe completion rates of vaginal delivery in total, nulliparous, and multiparous women were 79%, 72%, and 84%, respectively. There were no cases of neonatal asphyxia. The total incidence of neonatal respiratory disorders was 2.1%, but there were no cases of persistent pulmonary hypertension. The total incidence of postpartum hemorrhage requiring transfusion was 2.7%.ConclusionThe 1-day planned vaginal delivery of twins at 36–37 weeks' gestation appears valid and safe, and our findings suggest that it can be an option for the delivery of twins.

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“…This choice depends on multiple factors and remains controversial in numerous studies. Many important factors are involved when determining the delivery method, including women's parity, foetal weight, foetal presentation, gestational weight and maternal clinical conditions 6 . Some studies have explained that if both foetuses are in a cephalic presentation, the vaginal mode is preferred 7 .…”

Section: Introductionmentioning

confidence: 99%

Factors affecting elective cesarean section in women with multiple pregnancy in Caruban, Indonesia

et al. 2020

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Background: Caesarean sections have become the most popular method for delivering twin babies because of the safety concerns associated with a natural birth. This study aims to identify the maternal characteristics and obstetric parameters that serve as risk factors influencing caesarean delivery in twin pregnancies by comparing women delivering via caesarean section and vaginal birth. Methods: A retrospective chart review design was used to analyse 47 women with multiple pregnancies from the medical records at a primary referral hospital in East Java, Indonesia. Women delivering vaginally were then compared with women who underwent a caesarean section to identify any differences between the groups. Results: More women delivered by caesarean section than by vaginal birth. In this study, women were more likely to undergo a caesarean section if they had a previous history of undergoing a caesarean section or if there were no foetal malpresentations during their pregnancy. There was a significant difference in maternal age between groups. We found that foetal malpresentation did not significantly increase the likelihood of caesarean delivery in women with multiple pregnancies. Conclusions: The percentage of multiple pregnancies delivered via caesarean section is quite high. Similar to previous studies, we identified a few factors including foetal malpresentation and labour augmentation that did not significantly increase the risk of caesarean delivery. However, we suggest that there is more than one reason responsible for the increase in caesarean sections in multiple pregnancies.

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Risk factors for cesarean delivery and adverse neonatal outcome in twin pregnancies attempting vaginal delivery

Abstract: Nulliparity and nonvertex presentation of twin B were found to be associated with intrapartum cesarean delivery in twin pregnancies.

Cited by 17 publications

References 22 publications

Risk factors of unsuccessful vaginal twin delivery

Risk factors of unsuccessful vaginal twin delivery

Outcomes of ‘one-day trial of vaginal delivery of twins’ at 36–37 weeks' gestation in Japan

Factors affecting elective cesarean section in women with multiple pregnancy in Caruban, Indonesia

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