Short communication: Vaginal delivery can be considered in monochorionic diamniotic twins

Abstract

The outcomes of 60 sets of monochorionic diamniotic (MCDA) twins were compared with 218 sets of dichorionic diamniotic (DCDA) twins. The caesarean section rates for MCDA were similar to those for DCDA twins (56.6 versus 53.6%, P > 0.1). Although the number of babies with 5-minute Apgar score of <7 was significantly higher for vaginally delivered MCDA twins compared with that of DCDA twins (12 versus 3.5%, P < 0.001), the umbilical artery pH of <7.2 was similar (20 versus 13%, P > 0.05). Admission to neonatal intensive care unit (NICU) and neonatal mortality were also similar in both groups. Delivery by caesarean section was associated with increased admission to the NICU and neonatal mortality for MCDA twins when compared with vaginal delivery group. From this retrospective cohort study, we can conclude that vaginal delivery for MCDA twins appeared to be a reasonable management option when similar selection criteria for vaginal delivery of DCDA twins were applied.

Perinatal mortality and mode of delivery in monochorionic diamniotic twin pregnancies ≥32 weeks of gestation: a multicentre retrospective cohort study

“…In this study (n = 60 pregnancies), higher incidences of neonatal mortality and admission to a neonatal intensive care unit were found in MC twins born by caesarean section compared with vaginally delivered twins. 18 However, in this study data were not stratified by gestational age.…”

“…1,5,[7][8][9][10][11][12] The same holds as to the mode of delivery in relation to perinatal mortality. [13][14][15][16][17][18] However, previous studies on the subject have a small sample size, ranging from 50 to 160 continuing pregnancies ‡32 weeks of gestation, hampering reliable clinical recommendations. In view of this lack of evidence, we set up a nationwide multicentre study to assess perinatal mortality rates of MC diamniotic twins not complicated by TTTS.…”

Mode d’accouchement des grossesses gémellaires

“…À notre connaissance, il n'existe qu'une seule étude comparant spécifiquement la morbidité néonatale des grossesses MCBA versus les grossesses bichoriales biamniotiques (BCBA) [62]. Il s'agit d'une étude rétrospective, anglaise, comparant 60 paires de jumeaux MCBA et 218 paires de jumeaux BCBA.…”

“…Les taux de césarienne, avant et pendant travail, et de césariennes sur J2 étaient similaires dans les deux groupes. Le taux de score d'Apgar < 7 à 5 minutes était significativement plus élevé dans le groupe des MCBA nés par voie basse que dans le groupe des BCBA nés par voie basse [62]. Les taux de pH artériel ombilical < 7,20, d'admission en réanimation et de mortalité néonatale étaient similaires dans les deux groupes.…”

Entbindung von Mehrlingen, insbesondere von Zwillingen

“…Dass auch im Falle von monochorialen Zwillingen risikoarm die vaginale Geburt angestrebt werden kann, wurde vor kurzem an 60 Fällen gezeigt, die bis auf eine erhöhte Rate von Apgar-Werten ! 7 keine signifikanten Unterschiede zu den dichorialen Vergleichsgeburten aufwiesen [52] . Dennoch wird von diversen Experten die primäre Sectio als adäquater Geburtsmodus empfohlen.…”