Vaginal birth after cesarean delivery in the twin gestation

Abstract

Objective: The safety of vaginal birth after cesarean delivery (VBAC) in the singleton pregnancy has been known for many years. Despite this knowledge, most physicians feel the risk of VBAC in a twin pregnancy (TP) is too high despite the lack of documentation in the literature. We sought to determine if a VBAC for a TP carried greater risk than a singleton gestation.Methods: A retrospective study of all TP attempting VBAC from 1991 to 1999 were evaluated. The next three consecutive singleton pregnancies attempting VBAC also were evaluated. Comparisons were made for VBAC success and complications (blood loss, uterine rupture, hysterectomy, chorioamnionitis, blood transfusion, postpartum hemorrhage [PPH], and neonatal morbidity), and χ2 test of association or Student’s t tests were used where appropriate. Significance was set at P <0.05.Results: Nineteen TP met study criteria. There were 57 controls. Gestational ages were similar (TP 38.5; controls 38.7). The VBAC success rate was 84.2% for the TP and 75.4% for controls. The incidence of PPH was 5.3% for both groups. No PPH occurred in a TP with a successful VBAC. One uterine rupture occurred in the control group; none occurred in the TP group. No significant differences were found for any parameters tested, including 1- or 5-minute Apgar scores, venous or arterial pH, or neonatal intensive care unit admission.Conclusions: The option of VBAC for TP appears to be safe and shares a similar likelihood of success as a singleton pregnancy. In view of the lack of increased complications, this option should be offered to patients with TP who are eligible for VBAC.