Risk Factors for Cesarean Delivery and Adverse Neonatal Outcome in Twin Pregnancies Attempting Vaginal Delivery

Abstract

(Acta Obstet Gynecol Scand. 2018;97:845–851) Concerns regarding the safety of vaginal delivery for twins has persisted due to some patients’ and obstetricians’ perception that it may lead to increased morbidity and mortality for the second twin. The Twin Birth Study, though, demonstrated the safety of planned vaginal delivery as neither maternal risk or neonatal morbidity and mortality was decreased with planned cesarean delivery. Because of these study results, the American College of Obstetricians and Gynecologists and the Society of Maternal-Fetal Medicine have recommended that women with twin gestations where the first twin is in the cephalic presentation be counseled to plan a vaginal delivery. However, that study did not assess risk factors that could lead to an unplanned cesarean delivery and also did not report on outcomes for those pregnancies that did require an unplanned cesarean delivery. The goal of this study was to identify risk factors for both cesarean delivery and delivery-related neonatal morbidity and mortality among women who were attempting vaginal delivery of twins.