Combined vaginal-cesarean delivery of twins: risk factors and neonatal outcome – a single center experience

Aviram, Amir; Weiser, Itay; Ashwal‏, Eran; J, Bar; Wiznitzer, Arnon; Yogev, Yariv

doi:10.3109/14767058.2014.927430

Cited by 11 publications

(23 citation statements)

References 17 publications

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“…The significantly associated risk factors identified in our study for unplanned cesarean delivery were nulliparity and nonvertex presentation of twin B. The latter was consistent for both the V‐CS and the CS‐CS groups and corresponds with other recent observations demonstrating nonvertex presentation of twin B to be a risk factor for an emergency cesarean. However, most of those studies assessed only combined delivery as the primary outcome and did not relate to the risk factors of cesarean delivery of both twins during a trial of labor.…”

Section: Discussionsupporting

confidence: 91%

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Risk factors for cesarean delivery and adverse neonatal outcome in twin pregnancies attempting vaginal delivery

Schachter-Safrai

Karavani

Haj-Yahya

et al. 2018

Acta Obstet Gynecol Scand

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Section: Discussionsupporting

confidence: 91%

“…As for neonatal outcomes, it seems that twin B displayed higher morbidity rates including lower Apgar scores and hypoxic ischemic encephalopathy , although the absolute numbers are small.…”

Section: Introductionmentioning

confidence: 98%

Risk factors for cesarean delivery and adverse neonatal outcome in twin pregnancies attempting vaginal delivery

Schachter-Safrai

Karavani

Haj-Yahya

et al. 2018

Acta Obstet Gynecol Scand

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“…Other studies have reported dichorionic-diamniotic twins to have increased risk for conversion. 11 We demonstrated induction of labor to be significantly higher in the successful VD group as compared with conversion. We hypothesize this may be due to improved deliberate timing of delivery with induction of labor and higher likelihood of having a provider available who is skilled in breech deliveries and internal podalic versions as necessary.…”

Section: Discussionmentioning

confidence: 70%

“…20,22 Avirem et al found a slightly higher risk of hemorrhagic-ischemic encephalopathy in twin B who underwent conversion, however, reported comparable overall neonatal differences between groups. 11 Aviram et al did report higher rates of morbidity in twin B as compared with twin A, though they warn that the overall prevalence of adverse outcome was low; thus, caution should be taken in drawing practical implications from these results. 12 Multifetal gestations have been shown to require significantly higher health care resources and cost as compared with singleton pregnancies.…”

Section: Discussionmentioning

confidence: 98%

Rates of Cesarean Conversion and Associated Predictors and Outcomes in Planned Vaginal Twin Deliveries

et al. 2020

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Objective Twin vaginal deliveries (VDs) are often performed in the operating room (OR) given the risk of conversion to cesarean delivery (CD) for the aftercoming twin. We aim to investigate the rates of conversion to CD for planned twin VDs and identify predictors and outcomes of conversion. Study Design A retrospective cohort study of all women who underwent a planned twin VD at two large academic medical centers over 4 years. Demographic and outcome data were chart abstracted. Various statistical tests were used to evaluate the influence of perinatal variables on mode of delivery and identify possible predictors of conversion. Results Eight hundred and eighty-five twin deliveries were identified, of which 725 (81.9%) were possible candidates for VD. Of those, 237 (32.7%) underwent successful VD of twin A. Ninety-five (40.1%) had a nonvertex second twin at time of delivery. Conversion to CD occurred in 10 planned VDs (4.2%). Conversions were higher with spontaneous labor (relative risk [RR]: 2.1; 95% confidence interval [CI] 1.6–2.7; p = 0.003), and having an intertwin delivery interval greater than 60 minutes (RR: 5.1; 95% CI: 2.5–10.8; p < 0.001). Nonvertex presentation of twin B, type of delivery provider, or years out in practice of delivery provider were not significantly different between groups. There were no significant differences in neonatal outcomes between VD and conversion groups. There was a significant association between use of forceps for twin B and successful VD (p = 0.02), with 84.6% in the setting of a nonvertex twin B. Conclusion Successful VD was achieved in planned VD of twins in 95.8% of cases, and there were no significant differences in maternal and fetal outcomes between successful VD and conversion to CD for twin B. With the optimal clinical scenario and shared decision-making, performing vaginal twin deliveries in labor and delivery rooms should be discussed. Key Points

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“…According to studies, the distribution of fetal weight in relation to gestational age varies significantly, depending on the population and the time period. There is a difference of up to 11% in the average birth weight of newborns of different populations, at a certain gestational age, while the differences are even greater, exceeding 45% for the third percentage growth curve of the populations of these newborns [68][69][70][71][72][73][74].…”

Section: Discussionmentioning

confidence: 99%

Twin Pregnancies Labour Modus and Timing

Tsikouras¹,

Chalkidou²,

Bothou³

et al. 2021

Current Topics in Caesarean Section

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Twin pregnancies are categorized according to three factors, zygosity, chorionicity and amnionicity. Dizygotic twins are always dichorionic and diamniotic, where each twin has its own chorionic and amniotic sac. Monozygotic twins account for 1/3 of twin pregnancies and show higher morbidity and mortality. In monozygotic twins, chorionicity and amnionicity are determined by the time of zygote division. Chorionicity and amnionicity determine the risks of twin pregnancy. Morbitidies are shown notable decreasing tendency depending on improving of high risk obstetric and neonatal care, however is still discussed the optimum labour management in twin pregnancies Vaginal delivery in twin pregnancies is possible when both have cephalic presentation and in the late weeks of pregnancy during which the risks of prematurity are minimized. The aim of this review was the assessment and evaluation the impact of the labour modus and timing of termination of twin pregnancies due to rise of their occurrence based on scientific aspects of the new published literature on perinatal outcome.

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Combined vaginal-cesarean delivery of twins: risk factors and neonatal outcome – a single center experience

Abstract: Non-cephalic twin B at admission or following delivery of twin A poses higher risk for combined delivery. Neonatal outcome of twin B following combined delivery are comparable with those of vaginal delivery.

Cited by 11 publications

References 17 publications

Risk factors for cesarean delivery and adverse neonatal outcome in twin pregnancies attempting vaginal delivery

Risk factors for cesarean delivery and adverse neonatal outcome in twin pregnancies attempting vaginal delivery

Rates of Cesarean Conversion and Associated Predictors and Outcomes in Planned Vaginal Twin Deliveries

Twin Pregnancies Labour Modus and Timing

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