Retrospective evaluation of attempted vaginal deliveries in dichorionic twin pregnancies

Sabine Enengl,Peter Oppelt,Richard Bernhard Mayer,Philip Sebastian Trautner,Omar Shebl,Simon-Hermann Enzelsberger,Birgit Brandl

doi:10.1007/s00404-020-05882-y

Sabine Enengl, Peter Oppelt + Show 5 more

Open Access

https://doi.org/10.1007/s00404-020-05882-y

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Abstract

PurposeNumbers of planned cesarean deliveries are increasing in twin pregnancies, despite the lack of evidence for this approach, and the second twin is thought to be at risk for a poorer outcome. The aim of this study was to examine whether twins have a poorer outcome if an attempted vaginal delivery is changed to a cesarean section or combined delivery.MethodsThis retrospective data analysis included all women with dichorionic twin pregnancies attempting vaginal delivery over a 10-year period. Outcome parameters for the first and second twins relative to their mode of birth were compared. A correlation model between the interdelivery time interval and Apgar scores was calculated. Subgroup analyses assessing the birth mode of the first and second twins were conducted.ResultsA total of 248 women were enrolled in the study. The second twins had significantly lower values for outcome parameters, such as umbilical artery cord pH and Apgar scores in comparison with the first twins (P < 0.01). The subgroup analysis of birth modes in first and second twins showed a significantly poorer outcome in the cesarean section and combined delivery group (P < 0.05). The interdelivery time interval was significantly longer in the second twin cesarean section group (P < 0.01). There was no significant correlation between the interdelivery time intervals and Apgar scores (P > 0.05).ConclusionAlthough outcome parameters were significantly lower in second twins and twins born via secondary cesarean section, the clinical relevance of this appears to be negligible.

Highlights

Numbers of twin pregnancies are still increasing due to artificial reproductive technologies [1,2,3], and they account for approximately 1–3% of the total [4]
A large randomized controlled trial, the Twin Birth Study, concluded that a planned vaginal delivery does not significantly influence neonatal and maternal mortality and morbidity in comparison with a planned cesarean section if the first twin is in cephalic
There were only a few twins that met the definitions for severe neonatal asphyxia and low 5-min Apgar scores in the whole patient group included in this study, but this was because of the twin birth itself, and due to intrapartum complications, such as a pathological heart rate or placental abruption, which are never totally preventable

Summary

Introduction

Numbers of twin pregnancies are still increasing due to artificial reproductive technologies [1,2,3], and they account for approximately 1–3% of the total [4]. Twin deliveries are associated with higher rates of perinatal morbidity and mortality due to prematurity, intrauterine growth restriction, and complications resulting from monochorionicity [5,6,7,8,9]. A persistent increase in the planned cesarean sections is being seen in Europe, despite the lack of evidence for this approach and women’s preference for vaginal birth [11,12,13,14]. Several studies have been conducted to investigate the impact of various factors on the neonatal outcome for both twins, with contradictory results. A large randomized controlled trial, the Twin Birth Study, concluded that a planned vaginal delivery does not significantly influence neonatal and maternal mortality and morbidity in comparison with a planned cesarean section if the first twin is in cephalic

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