Excessive Use of Cesarean Section for the Second Twin?

Abstract

Background: In Sweden, the frequency of cesarean section of the second twin after vaginal birth of the first twin has increased in recent years. Methods: To investigate the indications for second twin cesarean sections, all twin deliveries at Huddinge University Hospital from 1995 to 1997 were reviewed retrospectively. The rates of cesarean section for the second twin were compared with figures from the whole country, based on the Swedish medical birth register. Results: Thirty-one percent of all twin deliveries had a spontaneous onset and spontaneous vaginal delivery. The total twin cesarean section rate, including cesarean section for the second twin, was 45% at Huddinge University Hospital in 1995–1997 and 44% in Sweden in 1995. Cesarean section for the second twin after vaginal delivery of the first twin occurred in 11%. On review, 2/3 of the cesarean sections for the second twin were considered potentially avoidable. Conclusion: In normal twin pregnancies with vertex/nonvertex presentation, the favorable fetal outcome and also the maternal risks associated with cesarean section support vaginal delivery as the recommended delivery route. Extraction or version of a second nonvertex twin should be attempted before cesarean section for this twin is performed.

Perinatal Outcome of the Second Twin at a Tertiary Care Center in India

“…Our observation regarding the distribution of fetal presentations is consistent with that of other studies [21,22]. Perinatal outcome of the second twin was unfavorable in vertex-vertex presentation than that in other two presentations.…”

Vaginal Delivery of Twins

“…[48][49][50][51] Whereas this increase may reflect the threat of litigation, we believe it more likely reflects the lack of training and/or experience on the part of obstetricians.…”

“…Wolff also reviewed the indication and outcome of cesarean section for the second twin after vaginal delivery of the first twin in a recent series. 48 Two thirds of the cesarean sections for the second twin were considered potentially avoidable. Of note, in these avoidable cases, no attempt at extraction of the second twin was made before cesarean delivery.…”

Effect of twin‐to‐twin delivery interval on umbilical cord blood gas in the second twins

“…Similar to the management of second stage in singleton pregnancies, any attempts to limit the twin-to-twin delivery interval by an arbitrarily defined cutoff undoubtedly increases the use of instrumental delivery or caesarean section, which may result in unnecessary fetal and maternal morbidities 7 . More recent studies have shown there is no increased risk in perinatal mortality 8 -10 or reduction in Apgar scores 11,12 of the second twin when the delivery interval was prolonged.…”