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

Mei, Jenny Y.; Muñoz, Hector E.; Kim, Jessica S.; Szlachta-McGinn, Alec; Blat, Cinthia; Rao, Rashmi; Han, Christina S.; Irani, Roxanna A.; Afshar, Yalda

doi:10.1055/s-0040-1718368

Cited by 5 publications

(4 citation statements)

References 30 publications

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“…Approximately 4-5% of twin vaginal trials of labor (VTOL) require a cesarean for the second twin birth. 9,10 According to this current case series, a DTI of > 30 minutes may indicate the need for cesarean delivery in 18 % of those cases, as opposed to its 5% risk within the entire data set of 320 cases. These ndings may have implications for those hospitals requiring su cient lead time for assembling an operative team which may be necessary to perform a cesarean delivery.…”

Section: Discussionmentioning

confidence: 85%

Twin Vaginal Deliveries: Impact of Delivery Time Interval on Twin B

Levine

Ginsberg

Delfinado

et al. 2021

Preprint

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Background:A vaginal twin delivery is a natural commonplace occurrence, but which can sometimes present a concern which may require action. Recently, the delivery time interval has been recognized as a variable that can be helpful for its safe conduct.Objectives:To view the delivery time interval in an obstetric population undergoing a twin vaginal trial of labor in consecutive deliveries during a specified time period.Study Design:A retrospective observational cohort of twin vaginal trials of labor was investigated to view the delivery time interval and its association with other factors, such as birth weights and the need for cesarean delivery of the second twin. The twin deliveries were divided into 2 groups, those with a delivery time interval of ≤ 30 minutes (Group A) and those with a delivery time interval of > 30 minutes (Group B), in a single institution.Results:No perinatal outcome difference was found between Group A (248 patients) or Group B (72 patients). However, 13 patients in Group B required a cesarean birth for a safe delivery, and 3 patients in Group A. The birth weight difference between each Baby A and Baby B varied according to the delivery time interval. Conclusion:The delivery time interval for vaginal twin deliveries may be useful to predict the need for a cesarean delivery of the second twin. The birth weight difference between Baby A and Baby B may be responsible for this finding.

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Section: Discussionmentioning

confidence: 85%

Twin Vaginal Deliveries: Impact of Delivery Time Interval on Twin B

Levine

Ginsberg

Delfinado

et al. 2021

Preprint

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“…Secondarily published data extracted from University of California Los Angeles (UCLA) electronic medical record database were used for certain model inputs. 12 The majority of assumptions utilized existing data from published research or otherwise available in the public domain. We designed a decision-analysis model to compare the cost effectiveness of two strategies of twin deliveries undergoing a trial of labor: (1) intended delivery in the LDR and (2) planned delivery in the OR.…”

Section: Methodsmentioning

confidence: 99%

Twin Vaginal Deliveries in Labor Rooms: A Cost-Effectiveness Analysis

et al. 2021

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Objective Twin vaginal deliveries (VDs) are often performed in the operating room (OR) given the theoretical risk of conversion to cesarean delivery (CD) for the aftercoming twin. We aim to evaluate the cost-effectiveness of performing VDs for twin gestations in the labor and delivery room (LDR) versus OR. Study Design We conducted a cost-effectiveness analysis using a decision-analysis model that compared the costs and effectiveness of two strategies of twin deliveries undergoing a trial of labor: (1) intended delivery in the LDR and 2) delivery in the OR. Sensitivity analyses were performed to assess strength and validity of the model. Primary outcome was incremental cost-effectiveness ratio (ICER) defined as cost needed to gain 1 quality-adjusted life year (QALY). Results In the base-case scenario, where 7% of deliveries resulted in conversion to CD for twin B, attempting to deliver twins in the LDR was the most cost-effective strategy. For every QALY gained by delivering in the OR, 243,335 USD would need to be spent (ICER). In univariate sensitivity analyses, the most cost-effective strategy shifted to delivering in the OR when the following was true: (1) probability of successful VD was less than 86%, (2) probability of neonatal morbidity after emergent CD exceeded 3.5%, (3) cost of VD in an LDR exceeded 10,500 USD, (4) cost of CD was less than 10,000 USD, or (5) probability of neonatal death from emergent CD exceeded 2.8%. Assuming a willingness to pay of 100,000 USD per neonatal QALY gained, attempted VD in the LDR was cost effective in 51% of simulations in the Monte Carlo analysis. Conclusion Twin VDs in the LDR are cost effective based on current neonatal outcome data, taking into account gestational age and associated morbidity. Further investigation is needed to elucidate impact of cost and outcomes on optimal utilization of resources. Key Points

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“…Some reports have shown increased adverse maternal outcomes relating to cesarean delivery of the second twin. [13][14][15][16][17][18][19] However, there have been contradictory reports regarding the effect of prolonged IDI on neonatal outcomes. 7 More specifically, some found IDI to be associated with less favorable neonatal outcomes of the second twin, including neonatal acidosis, lower Apgar scores, increased admissions to the neonatal intensive care unit (NICU), and mortality, 13,20 while others failed to demonstrate such adverse neonatal outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…While the standard cutoff might be 30 min, 11,12 no statistical method was used to show 30 min being superior to other cutoff points. Some reports have shown increased adverse maternal outcomes relating to cesarean delivery of the second twin 13–19 . However, there have been contradictory reports regarding the effect of prolonged IDI on neonatal outcomes 7 .…”

Section: Introductionmentioning

confidence: 99%

The optimal cutoff for intertwin delivery interval: A retrospective cohort study

Justman,

Somer,

Goldfreind

et al. 2024

Intl J Gynecology & Obste

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ObjectiveTo determine the cutoff of intertwin delivery intervals (IDIs) as a predictor for neonatal acidemia.MethodThis retrospective cohort study was conducted at a single tertiary care center. Women attempting vaginal delivery of twins between 2010 and 2019 and who reached the second stage of labor were included. The cutoff point for prolonged IDI was established using a receiver operating characteristic (ROC) curve and Youden's J statistic. Maternal and neonatal outcomes were compared between short and prolonged IDI cohorts.ResultsA total of 461 women were included in the study. A cutoff time of 10 min was found to be the best predictor for neonatal acidemia (arterial cord pH ≤ 7.1), with a sensitivity of 90% and a specificity of 59%. Second twins delivered more than 10 min after the first twin were more likely to be acidemic and to have a 5‐min Apgar score of 7 or less (13.5% vs 3.3%, P = 0.01, and 8.4% vs 3.2%, P = 0.02, respectively). An IDI of more than 10 min was also associated with increased rate of cesarean delivery and placental abruption (13.5% vs 0.8%, P < 0.001, and 3.4% vs 0.8%, P = 0.047, respectively). No other adverse maternal or neonatal outcomes were statistically significant between cohorts.ConclusionAn IDI of more than 10 min is associated with a higher risk for neonatal academia, with a low 5‐min Apgar score, and higher cesarean delivery and placental abruption rates. These findings provide insights that are valuable when counseling and managing twin pregnancies attempting vaginal delivery. Interventions aimed at shortening the IDI should be considered to prevent adverse neonatal outcomes.

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

Cited by 5 publications

References 30 publications

Twin Vaginal Deliveries: Impact of Delivery Time Interval on Twin B

Twin Vaginal Deliveries: Impact of Delivery Time Interval on Twin B

Twin Vaginal Deliveries in Labor Rooms: A Cost-Effectiveness Analysis

The optimal cutoff for intertwin delivery interval: A retrospective cohort study

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