Vaginal Delivery Of Twins Research Articles

Successful Management of Quadruplet Pregnancy following Spontaneous Conception

Introduction: When more than two fetuses simultaneously develop in the uterus, it is called higher order multiple pregnancy. The incidence of such pregnancies ranges from 0.01% to 0.07%.
 
 Case report: We report a case of 26-year-old G2P1L0D2 with previous history of preterm vaginal twin delivery, diagnosed to have quadruplet pregnancy. She was admitted at 28 weeks of gestation for safe confinement. At 33 weeks of gestation, emergency cesarean section was conducted with outcome of two female and two male babies with quadriamniotic and quadrichorionic placenta, without any intra and post-operative complications.
 
 Conclusion: A multidisciplinary approach with good neonatal care facilities is warranted for a better outcome in higher order multiple pregnancies.

Please exit safely: maternal and twin pair neonatal outcomes according to delivery mode when twin A is vertex

Objective: To investigate maternal and infant outcomes associated with delivery mode for twins with a cephalic presenting twin.Methods: Linked birth certificate and ICD hospital discharge data were analyzed retrospectively for 5573 mothers and their respective twin pairs born live at 34–42 weeks’ gestation, with twin A vertex, in Washington State from 1997–2007. Relative risks (RR) and 95% confidence intervals of adverse maternal and twin pair outcomes were calculated for vaginal delivery or cesarean during labor in comparison to cesarean without labor.Results: Vaginal delivery or cesarean during labor was associated with significantly elevated rates of maternal hemorrhage (RR = 2.8 [2.2,3.7]), infection (RR = 2.2 [1.5,3.3]), twin pair birth injury (RR = 2.6 [1.2,5.4]) and low 5-min Apgar scores (RR = 1.4 [1.1,1.8]) and with significantly lower rates of ventilation among preterm twin pairs only (RR = 0.8 [0.7,0.9]). The lowest rate of combined poor short-term outcomes occurred in mothers and twin pairs delivered by cesarean without labor (23%) and the highest rates occurred in those with operative vaginal or cesarean during labor (39% and 34%, respectively). Among women in labor, 35% of nulliparas achieved spontaneous vaginal delivery of both twins compared to 63% of non-nulliparas.Conclusion: For nulliparous women who carry twins to term, planned cesarean may improve outcomes.

Twin vaginal delivery is associated with lower umbilical arterial blood pH of the second twin and less intrapartum blood loss

Objective: To clarify actual differences in the neonatal as well as maternal outcome between completed twin vaginal delivery and cesarean delivery.Methods: We collected the data from women with a twin pregnancy who delivered two live fetuses between 1 January and 31 December 2014 at 20 teaching hospitals11 Participants: Adachi Hospital, Hyogo Prefectural Amagasaki General Medical Center, Japan Baptist Hospital, Kitano Hospital, Kobe City Medical Center General Hospital, Kosaka Women’s Hospital, Kurashiki Central Hospital, Kyoto University Hospital, Mitsubishi Kyoto Hospital, Nagahama Red Cross Hospital, National Hospital Organization Kyoto Medical Center, National Hospital Organization Osaka National Hospital, Osaka Red Cross Hospital, Otsu Municipal Hospital, Otsu Red Cross Hospital, Red Cross Wakayama Medical Center, Saiseikai Noe Hospital, Shizuoka General Hospital, Takamatsu Red Cross Hospital and Tenri Hospital. in Japan. Only the cases that were retrospectively regarded as eligible for planned vaginal delivery were analyzed according to the actual mode of delivery.Results: Umbilical arterial blood pH (UmA-pH) of the second twin was slightly but significantly lower in the vaginal delivery group (7.26 ± 0.009) than in a cesarean delivery group (7.30 ± 0.006). Vaginal delivery was the only independent risk factor for second twin’s UmA-pH <7.20. Intrapartum blood loss was significantly larger in the cesarean delivery group (1444 ± 63 g) than in the vaginal delivery group (820 ± 109 g). Cesarean delivery was an independent risk factor for intrapartum blood loss ≥1500 g.Conclusion: Twin vaginal deliveries were associated with slightly but significantly lower UmA-pH of the second twin, whereas twin cesarean delivery was associated with significantly larger intrapartum blood loss. Not only the neonatal risk but also the maternal risk should be taken into account when an optimal delivery mode for the twin pregnancy is considered.

Risk factors for obstetric anal sphincter injuries in twin deliveries: a retrospective review.

Risk factors for obstetric anal sphincter injuries (OASIS) have been well-established in singleton pregnancies. Considering the unique characteristics of twin deliveries, our aim was to identify risk factors for OASIS that are specific to twins. A retrospective study of all vaginal twin deliveries in a tertiary center between 2000 and 2014. Women who experienced OASIS (the OASIS group) were compared with those whose anal sphincter was intact (controls). Overall 717 women were eligible for the study, of whom 20 (2.8%) experienced OASIS. Women in the OASIS group were more likely to be nulliparous (95.0% vs 53.7%, p < 0.001) and were characterized by a higher gestational age at delivery (36.1 ± 2.5 vs 34.6 ± 3.3, p = 0.04), a higher birth weight for both twin A and twin B (2,507 ± 540g vs 2,254 ± 525g, p = 0.03, and 25,49 ± 420g vs 2,232 ± 606g, p = 0.004 respectively), and a higher rate of episiotomy (40.0% vs 14.2%, p = 0.001), instrumental delivery for twin A (80.0% vs 13.5%, p < 0.001) or twin B (80.0% vs 18.7%, p < 0.001), and inter-twin delivery interval of over 30min (20.0% vs 7.5%, p = 0.04). The only factor that remained significant on multivariate analysis was instrumental delivery: forceps delivery of twin A (OR = 8.8, 95% CI 2.6-30.1), vacuum extraction of twin A (OR = 9.2, 95% CI 2.6-34.6), and forceps delivery of twin B (OR = 15.4, 95% CI 4.9-48.6). In women with certain combinations of risk factors the risk of OASIS was as high as 30%. The overall rate of OASIS in twins is low and instrumental delivery, especially by forceps, is a risk factor.

Formation à la version par manœuvre interne et à la grande extraction lors de l’accouchement du deuxième jumeau

ObjectivesTo evaluate French residents in obstetrics and gynaecology's training to internal version and breech extraction during vaginal delivery of the second twin. MethodsA national descriptive survey conducted among 1064 residents between July and October 2014. Respondents were invited by email to specify the type of theoretical and practical training they had received, their university hospital obstetrical practices and the number of vaginal internal version and breech extraction of the second twin they had seen and performed. ResultsResponse rate was 38.7% (n=412). Regarding the type of theoretical training, 39.8% of residents (n=164) had received the obstetrical mechanics and techniques degree; 47.6% (n=196) had got a teaching during special education classes and 29.4% (n=121) a training on mannequin. There were important differences between regions. At the end of residency, 45.6% of residents (n=36) had practiced more than five vaginal internal version and breech extraction of the second twin. ConclusionInternal version and breech extraction are difficult but essential maneuvers for the management of twin delivery. The French residents in obstetrics and gynaecology's training for these maneuvers seems to be insufficient. It is necessary to improve their teaching, this teaching must also be equivalent between regions.

Fetal presentation and successful twin vaginal delivery

Despite the demonstrated safety of a trial of labor for pregnancies with a vertex-presenting twin and clinical guidelines in support of this plan, the rate of planned cesarean delivery for twin pregnancies remains high. This high rate, as well as variation in cesarean rates for twin pregnancies across providers, may be influenced strongly by concern about delivery of the second twin, particularly when it is in a nonvertex presentation. There are limited data in the literature that has examined the impact of the position of the nonpresenting twin on successful vaginal delivery or maternal/neonatal morbidity. We hypothesized that nonvertex presentation of the second twin would be associated with lower rates of successful vaginal birth for those patients attempting labor. This institutional review board-approved, retrospective cohort study of women who labored with twin pregnancies in a single urban hospital from 2007-2011. We included women with vertex-presenting first twins at >32 weeks gestation without a contraindication to labor and excluded those with uterine scar or lethal fetal anomaly. Vaginal delivery rates were evaluated according to vertex or nonvertex presentation of the second twin at admission and again at delivery. Maternal and neonatal morbidities were evaluated separately. Logistic regression was used to control for multiple confounders. Seven hundred sixteen patients met the inclusion criteria; 349 patients (49%) underwent a trial of labor. This included 73% (296/406) of eligible vertex/vertex twins and 17% (53/310) eligible vertex/nonvertex twins (P < .01). When compared with laboring patients with vertex/vertex-presenting twins, those with vertex/nonvertex twins were younger (median age, 32 vs 33 years; P= .05), were more often multiparous (60% vs 43%; P= .02), and were less likely to have hypertension (13% vs 27%; P= .03). Eighty-five percent of patients with nonvertex second twins at admission delivered vaginally, compared with 70% of patients with vertex second twins (P= .02). After we controlled for confounders, the difference was not statistically significant (adjusted odds ratio, 2.10; 95% confidence interval, 0.93-4.73). In the subset of patients with nonvertex second twins at delivery, those who initiated labor had an 89% vaginal delivery rate, compared with a 56% rate for those who changed from vertex to nonvertex presentation during labor (adjusted odds ratio, 19.90; 95% confidence interval, 3.86-102.78). Labor induction and increasing provider years in practice were also significant positive predictors of vaginal birth when the second twin was nonvertex at delivery. Maternal and neonatal morbidity was low and similar between groups, although 8% of women with nonvertex second twins experienced cervical lacerations, compared with 1% with vertex second twins (P= .01). Patients with nonvertex second twins had comparable, if not higher, rates of vaginal delivery than their vertex-presenting counterparts. The higher rate of vaginal delivery with stable nonvertex lie and the association with labor induction and the physician's years in practice all suggest a role for provider selection and delivery planning. These findings and the observed 11% rate of intrapartum presentation change support vaginal delivery of the nonvertex second twin.

Is the risk of obstetric anal sphincter injuries increased in vaginal twin deliveries?

Objective: Vaginal twin deliveries have a higher rate of intrapartum interventions. We aimed to determine whether these characteristics are associated with an increased rate of obstetric anal sphincter injuries compared with singleton.Study design: Retrospective study of all twin pregnancies undergoing vaginal delivery trial was conducted from January 2000–September 2014. Sphincter injury rate compared with all concurrent singleton vaginal deliveries. Multivariable analysis was used to determine twin delivery association with sphincter injuries while adjusting for confounders.Results: About 717 eligible twin deliveries. Outcome was compared with 33 886 singleton deliveries. Twin pregnancies characterized by a higher rate of nulliparity (54.8% versus 49.5%, p = 0.005), labor induction (42.7% versus 29.1%, p < 0.001), and instrumental deliveries (27.5% versus 16.7%, p < 0.001), lower gestational (34.6 ± 3.3 versus 38.8 ± 2.3, p < 0.001), and lower birth weight. Total breech extraction was performed in 29.0% (208/717) of twin deliveries. Overall obstetric sphincter injury rate was significantly lower in the twins group (2.8% versus 4.4%, p = 0.03, OR = 0.6, 95% CI 0.4–0.9), due to lower rate of 3rd degree tears in twins versus singletons (2.2% versus 4.0%, p = 0.02), rate of 4th degree tears similar among the groups (0.6% versus 0.4%, p = 0.5). In multivariable analysis, sphincter injuries were associated with nulliparity (OR = 3.9, 95% CI 3.4–4.5), forceps (OR = 6.8, 95% CI 5.8–7.8), vacuum (OR = 2.9, 95% CI 2.5–3.3), earlier gestational age (OR = 0.2, 95% CI 0.1–0.3), episiotomy (OR = 0.8, 95% CI 0.7–0.9), and birth weight over 3500 g (OR = 1.8, 95% CI 1.6–2.0). However, the association between twins (versus singletons) deliveries and sphincter injuries was lost after adjustment for delivery gestational age (OR = 0.7, 95% CI 0.4–1.2).Conclusion: Despite a higher rate of intrapartum interventions, the rate of sphincter injuries is lower in twins versus singleton deliveries, mainly due to a lower gestational age at delivery.

Trial of labour in twin pregnancies: a retrospective cohort study.

To assess the success rate of vaginal delivery among women with twin pregnancies; the Twin Birth Study has shown that vaginal delivery and caesarean section are equally safe for twin delivery but >40% of the planned vaginal delivery group delivered by caesarean section. A retrospective cohort study. A tertiary medical centre. A total of 2194 women with twin pregnancies not complicated with very low birthweight. Planned mode of delivery was documented in the woman's electronic record upon entering the delivery room. Information regarding maternal age at delivery, parity, gestational age, presentation, previous history of caesarean delivery, birthweight and Apgar score was collected from the obstetric electronic charts. Rate of vaginal twin delivery. Of the 2194 women included, 1311 twin pregnancies had planned caesarean delivery and 883 underwent a trial of labour. Of the 883 women who underwent a trial of labour, the rate of vaginal delivery was 86.9%, whereas the rates of caesarean delivery and combined vaginal-caesarean delivery were 11.1% and 2.0%, respectively. Presentation of second twin, gestational age and maternal age did affect the chances of success. Nulliparity [odds ratio (OR) 2.38, 95% confidence interval (95% CI) 1.4-4.05], Foley induction of labour (OR 2.33, 95% CI 1.38-3.91) and body mass index >30 kg/m(2) (OR 1.76, 95% CI 1.03-3) were independent risk factors for caesarean delivery. The rate of vaginal delivery among women with twin pregnancies who undergo labour can be high, especially in women who laboured spontaneously and have delivered before. The rate of vaginal delivery of twins can be high, especially in women who have delivered before.

Management of twins: vaginal or cesarean delivery?

Recent level I evidence from a single randomized-controlled trial has shown that there is no difference in fetal or neonatal outcomes (composite of fetal/neonatal death or serious neonatal morbidity) between planned cesarean delivery and planned vaginal delivery for twins between 32 and 38 6/7 weeks. As long as the presenting twin is vertex, vaginal delivery should be considered regardless of the presentation of the second twin. To avoid unnecessary cesarean deliveries and maternal morbidity, it is important to continue to train residents to perform obstetrics maneuvers necessary for vaginal delivery of twins such as vaginal breech extraction.

Twin pregnancy outcomes after increasing rate of vaginal twin delivery: retrospective cohort study in a Hong Kong regional obstetric unit

Objective: To determine any change in adverse neonatal/maternal outcomes after increasing the rate of vaginal twin delivery by comparing vaginal twin delivery and caesarean delivery with our previous cohort study.Methods: In a retrospective cohort study, all twins booked at a Hong Kong regional obstetrics unit were evaluated during a 3-year period from 1 April 2009 to 31 March 2012.Results: Out of the 269 sets of twins who eventually delivered in our unit, 68 (25.3%) of them were delivered vaginally, compared to 15.8% in our previous cohort study (p = 0.02). For those who were suitable for vaginal delivery, significantly more women attempted vaginal delivery: 93/133 (69.9%) versus 47/100 (47%) (p = 0.0005). The success rate for vaginal delivery and rate of requiring caesarean delivery for the 2nd twin were similar between these two periods. There were significantly more 2nd twins with cord blood pH < 7.2 when both twins were delivered by vaginal delivery. Otherwise, there was no significant difference between other neonatal/maternal morbidities.Conclusion: With proper counseling, significantly more women who were suitable for vaginal twin delivery would opt to do so. There was no significant increase in neonatal/maternal morbidities despite the increased rate of vaginal twin delivery.

Risk factors predicting an emergency cesarean delivery for the second twin after vaginal delivery of the first twin.

To investigate obstetrical risk factors predicting failure of vaginal delivery and an emergency cesarean section (CS) for the second twin after vaginal delivery of the first twin. In addition, the study was aimed to define perinatal outcomes of the second twin. A retrospective study was conducted, comparing all deliveries of twins in which CS was performed for the second twin to those in which both twins were delivered vaginally during the years 1988-2010. Women with multiple gestations in which a CS was performed for both twins were excluded from the study. During the study period, 1966 vaginal deliveries of the first twin were recorded; 192 involved emergency CS for the second twin. Risk factors for emergency CS of the second twin were preterm delivery, previous CS, placental abruption and breech presentation of the second twin. Perinatal outcomes did not differ between the groups. Risk factors for emergency cesarean section of the second twin are preterm delivery, previous CS, placental abruption and breech presentation. Nevertheless, short-term perinatal outcomes are comparable to twins delivered vaginally.

Intrapartum management of twin pregnancies: are uncomplicated monochorionic pregnancies more at risk of complications than dichorionic pregnancies?

To analyze mode of delivery and neonatal morbidity according to chorionicity in a hospital birth center with a policy of vaginal delivery for twins. Retrospective analysis over a 13-year period. Department of Obstetrics, University Hospital, Lille, France. In all, 1009 twin pregnancies were included, divided into 171 uncomplicated monochorionic pregnancies (17%) and 838 dichorionic pregnancies (83%). We compared the monochorionic and the dichorionic populations. Rate of cesarean section and neonatal outcome (umbilical artery pH, Apgar score and neonatal complications). The rate of cesarean sections was 45.7% with no difference found based on chorionicity. The reasons for elective cesarean section were mainly noncephalic presentation, which was more frequent in dichorionic than in monochorionic (48.8% vs. 37.2%, p = 0.025) pregnancies. Birthweight was lower in monochorionic twins (2249 ± 469 g vs. 2329 ± 478 g, p = 0.045). The rate of umbilical artery cord blood values with a pH < 7.10 was similar in monochorionic and dichorionic pregnancies. There was no difference in neonatal complications between the two groups. Monochorionic and dichorionic twin pregnancies had similar delivery outcomes. The neonatal outcome for twin 2 was not different between monochorionic and dichorionic pregnancies. Vaginal birth could be offered to women with twin pregnancies regardless of chorionicity.

A case report of a delayed-interval delivery in a dichorionic diamniotic twin pregnancy

Background: Twin gestation carries the risk of preterm delivery, which can result in neonatal morbidity and mortality. A delayed-interval delivery is a rare option when it is believed delayed arrival of the second twin will improve its outcome, provided there are no contraindications to the procedure. Case: Dichorionic diamnotic twins presented at 23w2d with previous preterm premature rupture of membranes in twin A, which resulted in spontaneous vaginal delivery of twin A at 26w1d followed by a delayed-interval delivery of twin B, eight days later at 27w2d via caesarean section. Conclusion: Since there are no guidelines on the procedure, case series and reports are a main source of information. Although successful outcomes have been documented, it is essential to explain the maternal, fetal and neonatal risks and benefits fully to the patient.

477: Mode of delivery and outcomes in twins less than 32 weeks gestation

Vaginal delivery of twins requires a provider experienced in vaginal breech delivery of the second twin. ACOG/SMFM suggest vaginal delivery is reasonable in diamniotic twin gestations ≥ 32-0/7 weeks with a vertex presenting twin. Evidence is limited regarding delivery mode for twins < 32 weeks. Our practice is to offer vaginal delivery to diamniotic twins with a vertex presenting twin, regardless of gestational age. The objective of this study was to evaluate outcomes of diamniotic twin pregnancies < 32 weeks by mode of delivery.

P18.06: Are perinatal outcomes in non complicated monochorionic diamniotic twins affected by birth management?

The vaginal delivery of monochorionic diamniotic twins after completed 32 gestational week of pregnancy is not associated with higher neonatal morbidity and mortality compared with those delivered by elective Caesarean section. Neccessary condition is close intrapartum monitoring and exclusion of cases with known or suspected twin-transfusion syndrome.

Selective uterine fundal pressure maneuver during the second stage of the first twin delivery at near term

Objective: We examined the perinatal outcomes of twin deliveries following selective uterine fundal pressure maneuver (UFPM) during the second stage of the first twin delivery.Methods: At our institute, if non-reassuring fetal heart rate and/or maternal exhaustion were observed during the second stage of the first twin, selective UFPM was performed following making sure of the position of the first twin’s buttocks by ultrasonography. We reviewed the obstetric records of all cases of trial of vaginal delivery of twins between 2002 and 2012.Results: A total of 64 cases were evaluated for the statistical analyses. Of these, selective UFPM for the first twin was performed in 15 cases (24%). Although the cases requiring selective UFPM for the first twin was associated with an increased postpartum hemorrhage, there were no significant differences in neonatal outcomes between the two groups.Conclusion: There was no evidence that the selective UFPM is unsafe for both mother and two babies during the second stage of the first twin delivery.

Successful Vaginal delivery of locked twin in a tertiary care centre of Western region of Nepal

Here we report a case of unbooked primigravida who was admitted to the labor room with labor pain. Ultrasonography revealed twin pregnancy with first twin presenting as breech. After coming head of the first breech fetus locked with the head of the second cephalic fetus during labor. Successful Vaginal delivery of both the live fetuses was performed along with mediolateral episiotomy following disengagement of head. Nepal Journal of Medical Sciences | Volume 03 | Number 01 | January-June 2014 | Page 74-75 DOI: http://dx.doi.org/10.3126/njms.v3i1.10366

Rebound increase in vaginal delivery for twins in a regional obstetric unit in Hong Kong

International Journal of Gynecology & ObstetricsVolume 126, Issue 1 p. 96-97 Brief communications Rebound increase in vaginal delivery for twins in a regional obstetric unit in Hong Kong Hiu Tung Tang, Corresponding Author Hiu Tung Tang helen.httang@gmail.com Department of Obstetrics and Gynecology, Kwong Wah Hospital, Hong KongCorresponding author at: Department of Obstetrics and Gynecology, N10, Kwong Wah Hospital, Waterloo Road, Hong Kong. Tel.: + 852 94961068; fax: + 852 35177983.Search for more papers by this authorAh Lai Liu, Ah Lai Liu Department of Obstetrics and Gynecology, Kwong Wah Hospital, Hong KongSearch for more papers by this authorWai Kuen Yung, Wai Kuen Yung Department of Obstetrics and Gynecology, Kwong Wah Hospital, Hong KongSearch for more papers by this authorTsz Kin Lo, Tsz Kin Lo Department of Obstetrics and Gynecology, Kwong Wah Hospital, Hong KongSearch for more papers by this authorWai Lam Lau, Wai Lam Lau Department of Obstetrics and Gynecology, Kwong Wah Hospital, Hong KongSearch for more papers by this authorWing Cheong Leung, Wing Cheong Leung Department of Obstetrics and Gynecology, Kwong Wah Hospital, Hong KongSearch for more papers by this author Hiu Tung Tang, Corresponding Author Hiu Tung Tang helen.httang@gmail.com Department of Obstetrics and Gynecology, Kwong Wah Hospital, Hong KongCorresponding author at: Department of Obstetrics and Gynecology, N10, Kwong Wah Hospital, Waterloo Road, Hong Kong. Tel.: + 852 94961068; fax: + 852 35177983.Search for more papers by this authorAh Lai Liu, Ah Lai Liu Department of Obstetrics and Gynecology, Kwong Wah Hospital, Hong KongSearch for more papers by this authorWai Kuen Yung, Wai Kuen Yung Department of Obstetrics and Gynecology, Kwong Wah Hospital, Hong KongSearch for more papers by this authorTsz Kin Lo, Tsz Kin Lo Department of Obstetrics and Gynecology, Kwong Wah Hospital, Hong KongSearch for more papers by this authorWai Lam Lau, Wai Lam Lau Department of Obstetrics and Gynecology, Kwong Wah Hospital, Hong KongSearch for more papers by this authorWing Cheong Leung, Wing Cheong Leung Department of Obstetrics and Gynecology, Kwong Wah Hospital, Hong KongSearch for more papers by this author First published: 19 March 2014 https://doi.org/10.1016/j.ijgo.2014.01.009Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume126, Issue1July 2014Pages 96-97 RelatedInformation

Outcomes of non-vertex second twins, following vertex vaginal delivery of first twin: a secondary analysis of the WHO Global Survey on maternal and perinatal health.

BackgroundMode of delivery remains a topic of debate in vertex/non-vertex twin pregnancies. We used the WHO Global Survey dataset to determine the risk of adverse maternal/perinatal outcomes associated with presentation of the second twin, following vaginal delivery of a vertex first twin.MethodsWe analysed a derived dataset of twin pregnancies ≥ 32 weeks gestation where the first twin was vertex and delivered vaginally. Maternal, delivery and neonatal characteristics and adverse outcomes were reported by presentation of the second twin. Logistic regression models (adjusted for maternal and perinatal confounders, mode of delivery and region) were developed to determine odds of adverse outcomes associated with presentation.Results1,424 twin pregnancies were included, 25.9% of these had a non-vertex second twin and Caesarean was more common in non-vertex presentations (6.2% vs 0.9%, p < 0.001). While the odds of Apgar < 7 at 5 minutes were higher in non-vertex presenting second twins (16.0% vs 11.4%, AOR 1.42 95% CI 1.01-2.00), the odds of maternal ICU admission (4.6% vs 1.7%, AOR 1.30, 95% CI 0.88-1.94), blood transfusion (6.0% vs 3.4%, AOR 1.23, 95% CI 0.67-2.25), stillbirth (7.6% vs 4.7%, AOR 1.15, 95% CI 0.72-1.73), early neonatal death (3.8% vs 2.1%, AOR 1.68, 95% CI 0.96-2.94), and NICU admission (26.6% vs 23.2%, AOR 0.93, 95% CI 0.62-1.39) were not.ConclusionAfter a vaginal delivery of a vertex first twin, non-vertex presentation of the second twin is associated with increased odds of Apgar <7 at 5 minutes, but not of other maternal/perinatal outcomes. Presentation of the second twin is not as important a consideration in planning twin vaginal birth as previously considered.

607: Fetal presentation and successful vaginal twin delivery

607: Fetal presentation and successful vaginal twin delivery