Labor and Delivery of Twin Pregnancies

Melka, Stephanie; Miller, James M.; Fox, Nathan S.

doi:10.1016/j.ogc.2017.08.004

Cited by 19 publications

(20 citation statements)

References 16 publications

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“…A recent review of studies of compression sutures for UA yielded an average success rate of 97% (range: 76 to 100%) [13], while an earlier review showed 91.7% [18]. Despite that our sample had generally higher obstetric risks associated with twin deliveries [19], our success rate was higher than the average success rates found in cesarean deliveries of singletons. Furthermore, although cesarean delivery is a high-risk factor for hysterectomy [20], none of our study sample underwent hysterectomy.…”

Section: Discussioncontrasting

confidence: 63%

Clinical outcomes of prophylactic compression sutures for treatment of uterine atony during the cesarean delivery of twins

Kim

Hur

Ryu

et al. 2020

BMC Pregnancy Childbirth

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Background Twin pregnancy has a high risk for developing uterine atony (UA). This study aimed to evaluate efficacy and clinical outcomes of prophylactic compression sutures to treat UA during twin cesarean section (CS). Methods All patient records of twin deliveries by CS after gestational age of 24 weeks in a large maternity hospital in South Korea between January 2013 and June 2018 were reviewed. Patients with monochorionic monoamniotic twins were excluded from data analysis. In total, 953 women were eligible for data analysis. Results Of the 953 patients, compression sutures were applied to 147 cases with postpartum bleeding that were refractory to uterine massage and uterotonics. Out of the 147, two patients (1.4%) proceeded to additional uterine artery ligation to achieve hemostasis, yielding a success rate of 98.6%. The rate of transfusion after the first 24 h of delivery in the suture group was not significantly different from that in the non-suture group, suggesting that both groups achieved hemostasis at an equal rate after the first 24 h of delivery. The difference in the operation time between the two groups was only 8.5 min. The rate of subsequent pregnancy among the patients who received compression sutures was 44.4%. Conclusions Overall, our findings suggest that with early and fast implementation of compression sutures, UA can be treated in the setting of twin cesarean delivery without significantly increasing maternal morbidity.

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Section: Discussioncontrasting

confidence: 63%

Clinical outcomes of prophylactic compression sutures for treatment of uterine atony during the cesarean delivery of twins

Kim

Hur

Ryu

et al. 2020

BMC Pregnancy Childbirth

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“…34 Therefore, vaginal delivery should be encouraged first, particularly for a normal term twin gestation with a cephalic presentation of the first twin. 35…”

Section: Discussionmentioning

confidence: 99%

What is an appropriate caesarean delivery rate for China: a multicentre survey

Zhang

Betrán

et al. 2021

BJOG

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Objective To assess the current status of caesarean delivery (CD) in China, propose reference CD rates for China overall, and by regions, investigate the main indications for CDs and identify possible areas for safe reduction. Design A multicentre cross‐sectional study. Setting A total of 94 hospitals across 23 provinces in China. Population A total of 73 977 randomly selected deliveries. Methods We used a modified Robson classification to characterise CDs in subgroups and by regions, and the World Health Organization (WHO) C‐Model to calculate reference CD rates. Main outcome measures CD rates in China. Results In 2015–2016, the overall CD rate in China was 38.9% (95% CI 38.6–39.3%). Considering the obstetric characteristics of the population, the multivariable model‐based reference CD rate was estimated at 28.5% (95% CI 28.3–28.8%). Accordingly, an absolute reduction of 10.4% (or 26.7% relative reduction) may be considered. The CD rate varied substantially by region. Previous CD was the most common indication in all regions, accounting for 38.2% of all CDs, followed by maternal request (9.8%), labour dystocia (8.3%), fetal distress (7.7%) and malpresentation (7.6%). Overall, 12.7% of women had prelabour CDs, contributing to 32.8% of the total CDs. Conclusions Nearly 39% of births were delivered by caesarean in China but a reduction of this rate by a quarter may be considered attainable. Repeat CD contributed more than one‐third of the total CDs. Given the large variation in maternal characteristics, region‐specific or even hospital‐specific reference CD rates are needed for precision management of CD. Tweetable abstract The caesarean rate in 2015–2016 in China was 38.9%, whereas the reference rate was 28.5%.

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“…The attending obstetrician must be alert and skillful to handle these situations that can happen in only a few minutes of time. In comparison, in the Twin Birth Study, the rate of Cesarean delivery in the planned vaginal delivery group was as high as 43.8% due to a too early timing of randomization [11,19].…”

Section: Plos Onementioning

confidence: 96%

“…In some conditions, the second fetus needs to be repositioned for a safe and quick delivery. It has been suggested that the high Cesarean delivery rate in twin pregnancies around the world mainly attributes to concern for management of non-vertex presented second twins [19]. Many retrospective studies on vaginal delivery for twin pregnancies were not designed to overcome such situation during patient enrollment.…”

Section: Plos Onementioning

confidence: 99%

Experience in different modes of delivery in twin pregnancy

et al. 2022

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Background/purpose Vaginal delivery, compared with Cesarean delivery, remains a less chosen mode of delivery for twin pregnancy. We studied the maternal and perinatal outcomes of twin pregnancy with different modes of delivery. Methods A retrospective study with data collected from a regional hospital, including vital twin pregnancies delivered at gestational age of 32 weeks and above. Medical charts were reviewed for prenatal conditions and postpartum outcomes. Results Ninety-eight pairs of twins were included and 44.9% were delivered via vaginal delivery. Women in the vaginal delivery group were significantly younger (32.5 ±4.3 years versus 34.8 ±4.6 years, p < 0.01), multiparous (34.1% versus 18.5%) and with more twins in vertex-vertex presentation (70.5% versus 33.3%) compared with women in the Cesarean delivery group. There were no differences between maternal postpartum complications and neonatal outcomes in both groups. The outcomes showed longer inter-twin delivery time interval (5.7 ± 5.6 versus 1.5 ± 0.9 min, p < 0.01), less estimated blood loss (198.7 ± 144.1 versus 763.2 ± 332.3 mL, p < 0.01), and shorter maternal hospital stay (3.0 ± 0.5 versus 5.7 ± 0.5 days, p< 0.01) in the vaginal delivery group. Twenty newborns had Apgar score below seven at birth. Logistic regression analysis revealed that low Apgar score was independently related to younger maternal age, maternal obstetric diseases and fetal non-vertex presentation. Gestational weeks and mode of delivery were not related to low Apgar score. Conclusion With careful case selection, vaginal delivery could be safely performed in twin pregnancies with less estimated blood loss and better recovery than Cesarean delivery.

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Labor and Delivery of Twin Pregnancies

Cited by 19 publications

References 16 publications

Clinical outcomes of prophylactic compression sutures for treatment of uterine atony during the cesarean delivery of twins

Clinical outcomes of prophylactic compression sutures for treatment of uterine atony during the cesarean delivery of twins

What is an appropriate caesarean delivery rate for China: a multicentre survey

Experience in different modes of delivery in twin pregnancy

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