Birth management and fetal outcome in multiple gestation: analysis of 1.444 births

Malfertheiner, Sara Fill; Weigl, M.; Dudakova, A.; Seelbach-Göbel, B

doi:10.1007/s00404-017-4559-6

Cited by 3 publications

(3 citation statements)

References 41 publications

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“…In a large-scale retrospective study, it was concluded that vaginal twin delivery appears safe if experienced staff monitor birth weight differences, birth interval, and blood values (15). In a comprehensive randomized study, no difference was observed between fetal and neonatal mortality rates and severe neonatal morbidity when comparing VB and CB in twin pregnancies between 32 and 38 weeks with the first twin in vertex presentation (4,14).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of vaginal birth safety in twin pregnancies with the first twin in cephalic presentation

Kahveci

Budak

2020

Preprint

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Objective: To evaluate vaginal birth safety by comparing the results of cesarean birth in twin pregnancies with the first twin in vertex presentation. Materials and methods: A retrospective cohort study of vertex-presenting twin pregnancies between 32 weeks 0 days and 38 weeks 6 days of gestation was conducted at our hospital from January 2013 to December 2015. The study population was divided according to the mode of birth. The primary outcome was early neonatal mortality, and secondary outcomes related to maternal and perinatal clinical characteristics were analysed between the groups. Results: Of 45,166 births, 1.92% (n = 869) were twin pregnancies. Of the 295 pregnancies meeting the study criteria, 30.16% (n = 89) were in the vaginal birth group, while the remaining 69.84% (n = 206) were in the cesarean birth group. In the vaginal birth group, all the first twins were delivered via vaginal birth, while among the second twins, 82.03% (n = 73) were delivered via vaginal birth, and the remaining 17.97% (n = 16) were delivered via cesarean birth. In the vaginal birth group, the early neonatal mortality rate was 2.24% (n = 2), and it was 0.97% (n = 2) in the cesarean birth group. All of the deaths occurred in pregnancies under 37 weeks of gestation. Conclusion: The neonatal outcomes between the vaginal birth and cesarean birth groups were similar in term pregnancies with the first in twin vertex presentation, whereas adverse neonatal outcomes were increased in the vaginal birth group in preterm second twin pregnancies. What is already known about this topic?Twin vaginal birth is often a clinical problem for obstetricians. Although there is no consensus on the optimal method of birth in twin pregnancies, many researchers suggest that if the first twin has a vertex presentation and vaginal birth is recommended. However, in most of the Western countries this conclusion has failed to increase the number of planned vaginal births for lower risk twins. What does this article add?This was a retrospective cohort study from a single tertiary centre. The neonatal outcomes between vaginal birth and cesarean birth were similar in term pregnancies with first twin cephalic presentation, whereas adverse neonatal outcomes were increased in the vaginal birth group in preterm second twin. Results of this study could help obstetricians and midwives inform women with twin pregnancies and make decisions about management during their labor.

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Section: Discussionmentioning

confidence: 99%

Evaluation of vaginal birth safety in twin pregnancies with the first twin in cephalic presentation

Kahveci

Budak

2020

Preprint

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“…Chorionicity is responsible for adverse perinatal outcomes for twins [ 3 , 7 , 8 ]. About half of all twins are born before 37 weeks’ gestation or with a birth weight < 2500 g [ 9 ]. Monochorionic twins have higher rates of mortality and morbidity than dichorionic twins and peripartal mortality is approximately twice as high than for dichorionic twins [ 4 , 7 , 10 , 11 ].…”

Section: Background/introductionmentioning

confidence: 99%

“…There has therefore been much discussion in the past about the optimal mode of birth for multiple pregnancies. Some studies have shown a higher risk of adverse outcomes for both twins or the second twin after vaginal birth compared to planned CS, which led to a large increase in CS rates during the last years [ 9 , 12 – 16 ]. The findings of the Twin Birth Trial were ambivalent with regard to vaginal versus caesarean birth for twin pregnancies: the study showed neither a significant increase or decrease in the risk of foetal or neonatal death or morbidity for twin pregnancies between 32 + 0 and 38 + 6 weeks of gestation, with the lead twin in cephalic position [ 17 ].…”

Section: Background/introductionmentioning

confidence: 99%

Mode of birth in monochorionic versus dichorionic twin pregnancies: a retrospective study from a large tertiary centre in Germany

Wandel

Abele

Pauluschke‐Fröhlich

et al. 2022

BMC Pregnancy Childbirth

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Background Optimal mode of birth for twins, in particular monochorionic twins, has been the subject of much debate. This retrospective study compared maternal and newborn outcomes after vaginal birth in monochorionic and dichorionic twins, utilizing a large institutional database. Methods Retrospective analysis focusing on 98 monochorionic-diamniotic (MC-DA) and 540 dichorionic-diamniotic (DC-DA) twin births extracted from the perinatal database of a large German hospital. Pregnancies ≥36 weeks of gestation with two viable foetuses born between 2004 and 2014 divided into planned vaginal and planned caesarean delivery were included. Descriptive analysis was performed for maternal characteristics. Odds ratios (OR) with 95% confidences intervals (CI) tested the predictive effect of vaginal birth on neonatal and maternal outcomes. Results 51.0% MC-DA and 46.7% DC-DA twin pregnancies were planned vaginal births and 44.0% MC-DA mothers and 43.7% DC-DA mothers actually gave birth vaginally. The overall rate of caesarean section (CS) during the years under observation was 79.6% for MC-DA and 77.0% for DC-DA pregnancies. There were no significant differences in neonatal outcome between the subsamples, although acidosis was observed more often in the second DC-DA twin and Apgar scores < 7 were observed more often in MC-DA twins. Conclusion Vaginal birth may be recommended as an option to women with monochorionic twins as no significant differences in outcomes were found between MC-DA and DC-DA twins. However, over half of planned vaginal twin births resulted in CS.

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Maternal and pregnancy predictive risk factors for having a compensated maternal injury claim: a Swedish nationwide cohort study

Ivert,

Holowko,

Liu

et al. 2023

Sci Rep

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To describe trends and identify maternal and pregnancy predictive risk factors for having a compensated claim for a maternal injury during delivery, as a proxy for having received suboptimal care. This nationwide retrospective cohort study included 1 754 869 births in Sweden between 2000 and 2016, including 4488 maternal injury claims filed with The National Swedish Patient Insurance Company (Löf), of which 1637 were compensated. Descriptive statistics on maternal and pregnancy characteristics, trends in filed/compensated claims over time, and distribution of compensated claims by clinical classification are presented. Characteristics associated with suboptimal care were identified using multivariable logistic regression, with mutual adjustment in the final model. Compensated claims were sorted into 14 clinical classifications (ICD-10 codes for main condition, injury, and causality). Overall, there was a two-fold increase in filed claims from 2000 to 2016, peaking in 2014. The rate of compensated claims only increased marginally, and 36.5% of filed claims were deemed avoidable. Perineal and pelvic floor injuries, as well as medical and diagnostic errors, were responsible for the majority of compensated claims. Women with a previous caesarean section, post term delivery, chronic or gestational disease, > 13 antenatal visits, or a multiple pregnancy had increased risk of having a compensated claim for a maternal injury during delivery. Understanding the risk factors for having a compensated maternal injury claim may guide health workers and maternity wards in improving the quality and organisation of care to reduce the risk of childbirth related injuries.

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Birth management and fetal outcome in multiple gestation: analysis of 1.444 births

Abstract: We conclude a vaginal delivery of twin appears safe if experienced staff monitor birth weight discrepancies, birth interval, and blood values consequently. A good outcome also for the second twin delivered spontaneously is nevertheless feasible if experienced staff is available.

Cited by 3 publications

References 41 publications

Evaluation of vaginal birth safety in twin pregnancies with the first twin in cephalic presentation

Evaluation of vaginal birth safety in twin pregnancies with the first twin in cephalic presentation

Mode of birth in monochorionic versus dichorionic twin pregnancies: a retrospective study from a large tertiary centre in Germany

Maternal and pregnancy predictive risk factors for having a compensated maternal injury claim: a Swedish nationwide cohort study

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