Abstract
BackgroundSpontaneous vaginal twin delivery after 32nd week of gestation is safe when first twin presenting cephalic. Aim of this study is to identify obstetric factors influencing the condition of second twin and to verify whether non-cephalic presentation and vaginal breech delivery of the second twin is safe.MethodsThis is a retrospective case controlled cohort study of 717 uncomplicated twin deliveries ≥32 + 0 weeks of gestation from 2005 to 2014 in two tertiary perinatal centers. Obstetric parameters were evaluated in three groups with descriptive, univariate logistic regression analysis for perinatal outcome of second twins.ResultsThe three groups included twins delivered by elective cesarean section ECS (n = 277, 38.6%), by unplanned cesarean section UPC (n = 233, 32.5%) and vaginally (n = 207, 28.9%). Serious adverse fetal outcome is rare and we found no differences between the groups. Second twins after ECS had significant better umbilical artery UA pH (p < 0.001) and better Apgar compared to UPC (p = 0.002). Variables for a fetal population “at risk” for adverse neonatal outcome after vaginal delivery (UA pH < 7.20, Apgar 5´ < 9) were associated with higher gestational age (p = 0.001), longer twin-twin interval (p = 0.05) and vacuum extraction of twin A (p = 0.04). Non-cephalic presentation of second twins was not associated (UA pH < 7.20 OR 1.97, CI 95% 0.93–4.22, p = 0.07, Apgar 5´ < 9 OR 1.63, CI 95% 0.70–3.77, p = 0.25, Transfer to neonatal intermediate care unit p = 0.48). Twenty-one second twins (2,9%) were delivered by cesarean section following vaginal delivery of the first twin. Even though non-cephalic presentation was overrepresented in this subgroup, outcome variables were not significantly different compared to cephalic presentation.ConclusionsEven though elective cesarean means reduced stress for second twins this seems not to be clinically relevant. Non-cephalic presentation of the second twin does not significantly influence the perinatal outcome of the second twin but might be a risk factor for vaginal-cesarean birth.
Highlights
Spontaneous vaginal twin delivery after 32nd week of gestation is safe when first twin presenting cephalic
Despite elective Cesarean in twin pregnancies without maternal and neonatal risk factors shows better primary outcome this seems clinically not relevant when twin A is presented in cephalic
Even vaginal delivery of the second twin in breech presentation seems to be safe for management of the second twin after completed 32nd weeks of gestation
Summary
Spontaneous vaginal twin delivery after 32nd week of gestation is safe when first twin presenting cephalic. A prospective randomized trial showed that vaginal delivery in uncomplicated twin pregnancies after 32 + 0 gestational weeks is possible and safe if the first twin is in cephalic position [6]. In these cases it is recommended that women be counseled to attempt vaginal delivery [7]. One small randomized trial suggests that in twins with noncephalic presentation after the thirty-fifth gestational week the neonatal outcome of the second twin is not significantly influenced by the route of delivery [10]. A trial of labor is successful in 77% [12]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
