Outcomes of ‘one-day trial of vaginal delivery of twins’ at 36–37 weeks' gestation in Japan

Abstract

ObjectiveThe lack of obstetricians in Japan has prevented the implementation of a 24–hour delivery monitoring system for high-risk deliveries such as twin vaginal delivery at many obstetric facilities. To examine the outcomes of a 1-day trial of the vaginal delivery of twins at 36–37 weeks' gestation.MethodsWe induced the vaginal delivery of twins at 36–37 weeks' gestation of 256 women who provided consent between January 2007 and December 2016 using the following protocol: 1) administration of 0.5 mg oral prostaglandin E2 every 1 hour (maximum: 1.5 mg) in the morning; 2) intravenous administration of oxytocin and amniotomy in the afternoon; and 3) selection of caesarean delivery when vaginal delivery was not expected by evening. We examined their perinatal outcomes in a chart review.ResultsThe completion rates of vaginal delivery in total, nulliparous, and multiparous women were 79%, 72%, and 84%, respectively. There were no cases of neonatal asphyxia. The total incidence of neonatal respiratory disorders was 2.1%, but there were no cases of persistent pulmonary hypertension. The total incidence of postpartum hemorrhage requiring transfusion was 2.7%.ConclusionThe 1-day planned vaginal delivery of twins at 36–37 weeks' gestation appears valid and safe, and our findings suggest that it can be an option for the delivery of twins.

Influence of platelet counts on postpartum hemorrhage in elective cesarean section for Japanese twins

“…CS for twins is recognized as a risk factor for serious PPH. 9,15 -17) Even if the risk is known, the rate of CS will not decrease in Japan 17,18) and it may be markedly difficult to avoid the risk of PPH due to CS for twins.…”