Attempted vaginal versus planned cesarean delivery in 195 breech first twin pregnancies.
Sentilhes L, Goffinet F, Talbot A, Diguet A, Verspyck E, Cabrol D, Marpeau L.
Department of Obstetrics and Gynaecology, Rouen University Hospital - Charles Nicolle, Rouen, France. loicsentilhes@hotmail.com
BACKGROUND: To compare neonatal and maternal outcomes for breech first twins according to whether vaginal or cesarean delivery was planned and to verify that in appropriate selected cases, attempted vaginal delivery is a reasonable choice.
METHODS: A retrospective study of all twin pregnancies with the first twin in breech position and gestational age at least 35 weeks at birth at two French university hospital centers from January 1994 through December 2000. The primary outcome was a combined indicator of neonatal mortality and severe morbidity, as defined by one or more of the following: death before discharge, admission to neonatal intensive care unit, 5-minute Apgar score <7, cord blood pH <7.10, or birth trauma.
RESULTS: Cesarean delivery was planned for 71 (36.4%) patients, and attempted vaginal delivery for 124 (63.6%), 59 (47.6%) of whom were delivered vaginally and 65 (52.4%) by cesarean during labor. Neither the combined negative outcome indicator nor neonatal mortality differed significantly for either twin or either group. There were no significant differences in maternal mortality or morbidity between the two groups. The frequency of deep vein thrombophlebitis or pulmonary embolism requiring anticoagulant therapy was significantly higher in the planned cesarean group [3/71 (4.2%) versus 0/124; p=0.047].
CONCLUSION: When appropriate criteria are used to decide mode of delivery, a careful intrapartum protocol is followed, and an experienced obstetrician, midwife, and anesthesiologist are in attendance, attempted vaginal delivery is a reasonable option for first twins in breech position.
PMID: 17230290 [PubMed - indexed for MEDLINE]
First breech twin pregnancy: Can we still accept a vaginal delivery? Comparative study of perinatal outcome with attempt of vaginal delivery versus planned cesarean: 166 cases
Bats AS, Marie V, Sentilhes L, Cabrol D, Goffinet F.
Université Paris-Descartes Paris V, Faculté de Médecine René-Descartes, Service de Gynécologie et Obstétrique de Port-Royal, Hôpital Cochin Saint-Vincent-de-Paul (AP-HP), 123, boulevard de Port-Royal, 75014 Paris.
OBJECTIVES: To evaluate practices and perinatal outcome in planned routes of delivery for first breech twins.
MATERIALS AND METHODS: A retrospective study in first breech twin pregnancies with a gestational age of at least 35 weeks at onset of labor. Maternofetal pathologies known to be associated with a poor neonatal outcome were excluded. A low neonatal outcome was defined by at least one of the following criteria: neonatal death, 5-minute Agar Score attempt of vaginal delivery (AVD) and planned cesarean section (PCS).
RESULTS: Among 166 included patients, an AVD has been performed in 105 cases (63.3%) and a PCS in 61 (36.8%). In AVD group, 46 women (43.8%) delivered vaginally. Low neonatal outcome was not significantly different in AVD group compared with PCS group (9 (8.6%) versus 6 (9.8%); p = 0.78 for the first twin and 7 (6.7%) versus 2 (3.3%); p = 0.49 for the second twin). There was no significant difference in maternal morbidity between the two groups. As a general rule, established practices for deciding route of delivery and labor have been applied in our department.
CONCLUSION: No excess of neonatal risk in AVD group compared with PCS was observed. These results could be extrapolated to centers applying a careful protocol to decide the route of delivery and labor practices.
PMID: 17003746 [PubMed - indexed for MEDLINE]
Vaginal delivery of the nonvertex second twin.
Fishman A, Grubb DK, Kovacs BW.
Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles.
OBJECTIVE: The purpose of our study was to test the hypothesis that there is no increased morbidity or mortality associated with vaginal delivery of the nonvertex second twin.
STUDY DESIGN: The medical records of 781 consecutive twin gestations achieving a gestational age > or = 20 weeks and delivering between Jan. 1, 1985, and Dec. 31, 1988, were reviewed. All live-born, vaginally delivered second twins were identified, grouped by presentation, and compared with respect to 5-minute Apgar scores, length of neonatal hospital stay, neonatal intensive care unit admissions, and neonatal deaths.
RESULTS: Of the 390 live-born, vaginally delivered second twins, 207 were delivered as vertex and 183 were delivered as breech. Ninety-five percent of the breech deliveries were total breech extractions. There were no statistically significant differences between the vaginal breech and vaginal vertex deliveries in any of the neonatal outcome measures studied even when stratified by birth weight.
CONCLUSIONS: These results support the null hypothesis and suggest that vaginal delivery of the nonvertex second twin is a safe intrapartum management option, although no conclusion can be reached in infants weighing < 1500 gm. We found no evidence of excessive morbidity or mortality associated with total breech extraction of the second twin.
PMID: 8456893 [PubMed - indexed for MEDLINE]
Neonatal outcome of second twins depending on presentation and mode of delivery.
Bjelic-Radisic V, Pristauz G, Haas J, Giuliani A, Tamussino K, Bader A, Lang U, Schlembach D.
Department of Obstetrics and Gynecology, Medical University of Graz, Austria. vesna.bjelic-radisic@klinikum-graz.at
Our objective was to examine the neonatal outcome of second twins depending on presentation and mode of delivery. Using a database we analyzed the short-term neonatal outcome in twin pregnancies offered a trial of labor with special emphasis on the second twin depending on presentation and mode of delivery. Neonatal outcome was evaluated by Apgar scores, umbilical cord blood pH values, and perinatal or neonatal morbidity and mortality.
Overall, in 219 (78%) of 281 pregnancies successful vaginal birth (VB) of both twins (VB-VB) was possible, 48 (17%) women had to be delivered by cesarean section (CS) of both twins (CS-CS), and in 14 (5%) women the second twin had to be delivered by CS after VB of the first twin (VB-CS). Successful VB was most common for vertex-vertex (V/V; n=171, 82%) and vertex-nonvertex (n=48, 75%) presentation (V/NV).
Twins delivered by VB-CS had the lowest values for pHart (p=.006) and pHven (p=.010). pHart less than or equal to 7.00 values occurred only in second twins delivered VB-VB or VB-CS. Lower Apgar scores of the second twin occurred more frequently in the VB-CS and in the VB-VB than in the CS-CS groups (ps<.05). Lower levels of pHart (p=.002) and frequency of pHart less than or equal to 7.00 occurred more often in nonvertex second twins than in vertex second twins (p<.022). The high CS rate in V/NV presentation and the significantly worse perinatal short-term outcome of NV second twins after VB of the first twin underline that randomized studies are necessary to evaluate the best delivery mode for V/NV twins.
PMID: 17564511 [PubMed - indexed for MEDLINE]
