Combined vaginal-cesarean delivery of twins: risk factors and neonatal outcome – a single center experience. (March 2015)

• Record Type: Journal Article
• Authors: Aviram, Amir; Weiser, Itay; Ashwal, Eran; Bar, Jonathan; Wiznitzer, Arnon; Yogev, Yariv
• Is Part Of: Journal of maternal-fetal & neonatal medicine. Volume 28:Number 5(2015)
• Page Start: 509
• Page End: 514
• Publication Date: 2015-03
• Subjects: Obstetrics -- Periodicals; Perinatology -- Periodicals; Infants (Newborn) -- Diseases -- Periodicals; Neonatology -- Periodicals; 618.2
• DOI: 10.3109/14767058.2014.927430
• Languages: English
• ISSNs: 1476-7058

Abstract

<abstract> <title>Abstract</title> <p> <italic>Objective</italic>: We aimed to characterize risk factors for combined twin delivery and assess neonatal outcome.</p> <p> <italic>Methods</italic>: This was a retrospective cohort study of all women admitted for trial of labor (TOL) with twin gestation, in a single, tertiary, university-affiliated medical center. Eligibility was limited to gestations with twin A delivered vaginally.</p> <p> <italic>Results</italic>: During the study period, 44 263 women delivered in our center, of whom 1307 (2.9%) delivered twins. Overall, 221 out of 247 women (89.5%) undergoing TOL delivered twin A vaginally. Parturients who delivered twin B by cesarean delivery (<italic>n</italic> = 23) were compared with those delivered twin B vaginally (<italic>n</italic> = 198). Multivariate analysis demonstrated that risk factors combined delivery were included non-cephalic twin B at admission (aOR 11.5, 95% CI 3.8–34.9, <italic>p</italic> < 0.001) or after delivery of twin A (aOR 17.7, 95% CI 6.6–47.2, <italic>p</italic> < 0.001), and dichorionic–diamniotic (DCDA) twins (aOR 8.9, 95% CI 1.8–44.0, <italic>p</italic> = 0.008). Spontaneous version of a cephalic twin B was not found to increase the risk (above the baseline risk of non-cephalic twin B) for combined delivery. Combined delivery was associated with slightly higher risk for hemorrhagic-ischemic encephalopathy of twin B (4.3% versus 0%, <italic>p</italic> = 0.003).</p> <p> <italic>Conclusion</italic>: Non-cephalic twin B at admission or following delivery of twin A poses higher risk for combined delivery. Neonatal outcome of twin B following combined delivery are comparable with those of vaginal delivery.</p> </abstract>