Twin vaginal delivery is associated with lower umbilical arterial blood pH of the second twin and less intrapartum blood loss

Sato, Yukiyasu; Emoto, Ikuko; Maruyama, Shunsuke; Taga, Atsuko; Fujii, Takaaki

doi:10.3109/14767058.2015.1118039

Cited by 5 publications

(5 citation statements)

References 14 publications

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“…Our data showed that CS was significantly associated with postpartum haemorrhage. There were studies supporting our finding that mothers in the CS group were significantly more likely to have hemorrhage and surgical complications 23,29 , whereas other studies showed that mothers were more likely to suffer from haemorrhage with VD 30 . There were also studies with neutral findings showing no significant differences in postpartum haemorrhage rates between CS and VD 31,32 .…”

Section: Maternal Outcomes and Mode Of Deliverysupporting

confidence: 80%

“…The retrospective cohort study in 2005 with 8073 twin births reported that CS reduced the risk of perinatal death of twins by approximately 75% 4 . Afterwards, several studies also reported that CS reduced perinatal and neonatal morbidities and mortalities [21][22][23] . However, the Twin Birth Study in 2013 with 1398 women between 32+0 to 38+6 weeks of gestation and twins in vertex presentation reported no significant differences between planned CS and planned VD in neonatal morbidities and mortalities 5 .…”

Section: Fetal Outcomes and Mode Of Deliverymentioning

confidence: 98%

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Trends in Caesarean section rates for twin pregnancies: a 20-year cohort study

Wong

Kong

2019

Hong Kong Journal of Gynaecology, Obstetrics and Midwifery

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Objective: To evaluate trends in Caesarean section (CS) rates for twin pregnancies over 20 years in a regional obstetric unit in Hong Kong. Methods: Data on twin deliveries between 1998 and 2017 at United Christian Hospital were collected. CS rates were calculated for each calendar year, and data were stratified into four 5-year intervals to determine trends. Twins delivered vaginally or by CS were compared in terms of maternal epidemiological risk factors, pregnancy characteristics, and pregnancy outcome. A logistic regression model was used to determine significant risk factors associated with CS. Results: From 1998 to 2017, 1083 (1.24%) of 87 480 deliveries were twin deliveries. The total CS rate for twins progressively increased from 58.9% in 1998-2002 to 84.1% in 2013-2017, particularly the CS rate for cephalic + cephalic twins from 41.7% in 1998-2002 to 74.7% in 2013-2017. The CS rate for non-cephalic first twin was close to 100% for all intervals. Logistic regression analysis showed that CS was positively associated with noncephalic presentation of the first twin (odds ratio [OR]=13.1), previous CS (OR=4.19), and advanced maternal age (OR=1.7) and negatively associated with preterm delivery (OR=0.34), multiparity (OR=0.29), and induction of labour (OR=0.086). For perinatal outcome, CS was significantly associated with higher mean birthweight, lower incidence of adverse perinatal or neonatal outcome but higher risks of postpartum haemorrhage. Conclusion: A progressive increase in CS rates for twins was observed over the past 20 years, particularly among cephalic-presenting twins, despite the lack of clear evidence on the preferred mode of delivery for such twin pregnancies.

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Section: Maternal Outcomes and Mode Of Deliverysupporting

confidence: 80%

Section: Fetal Outcomes and Mode Of Deliverymentioning

confidence: 98%

Trends in Caesarean section rates for twin pregnancies: a 20-year cohort study

Wong

Kong

2019

Hong Kong Journal of Gynaecology, Obstetrics and Midwifery

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“…Twin-to-twin delivery time interval was reported to be negatively correlated to the umbilical cord blood pH, and shorter DTI might improve the neonatal outcome for the second twins [22,23]. It was reported that DTI over thirty minutes was strongly associated with higher risks of fetal acidosis and low Apgar score in the second twin [24].…”

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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“…Additionally, in the second twins the percentage of umbilical arterial blood pH below 7.20 was significantly higher in VD than this in CS group (20% vs 4%; p = 0.0001). 8 Ylilehto et al showed that umbilical arterial blood pH < 7.05 appeared more often in VD second twins than in second CS twins (p = 0.003). 24 The team headed by Leung draws attention to the effect of delivery interval between twins and the duration of the 2 nd stage of labor.…”

Section: Discussionmentioning

confidence: 98%

“…6,7 Some authors reported that factors such as chorionicity, mode of delivery, type of fetal growth (discordant or symmetric), and birth mass worsen perinatal outcomes and increase the rate of neonatal complications in the second twin compared to the first one. [8][9][10] On the other hand, broad trials have been conducted which did not show the superiority of CS vs VD in terms of complications in neonates, especially in the absence of risk factors and when the first twin is in the cephalic presentation. [11][12][13] The authors of the meta-analysis from 2011, which included nearly 40,000 twin pairs, concluded that, in the absence of risk factors, VD is safer than CS for the first twin but for the second twin, the mode of delivery had no effect on perinatal outcome.…”

Section: Introductionmentioning

confidence: 99%

Postnatal condition of the second twin in respect to mode of delivery, chorionicity and type of fetal growth

Florjański¹,

Homola²,

Fuchs³

et al. 2019

Adv Clin Exp Med

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Background. The increased use of assisted reproductive techniques (ART) contributes to the increased rate of twin pregnancies, which are burdened with a higher risk of complications. Factors that affect the condition of the second twin are understudied. Objectives. The objective of this study was to assess the impact of the delivery mode, chorionicity, amnionicity, and the type of fetal growth on the postnatal condition of the second twin. Material and methods. The study included data from 475 pregnant women with twin pregnancies. Maternal age, parity, chorionicity, amnionicity, type of fetal growth, mode of delivery, gestational weeks at delivery, Apgar score, and umbilical arterial blood pH were retrospectively analyzed. Data normality was checked with the Kolmogorov-Smirnov test. The paired Wilcoxon signed-rank test and χ 2 test were used for comparisons between groups. To check predictive value of the analyzed variables multiple linear regression was used. Results. The mean maternal age was 29.22 (standard deviation (SD) ±5.19) years. The maternal age and gestational age at delivery did not differ significantly between women who delivered by cesarean section (CS) and vaginal delivery (VD). In the second twin, the Apgar score and values of arterial umbilical blood pH were lower in infants delivered by VD than in those delivered by CS (6.30 ±2.83 and 7.30 ±0. 12; p = 0.0209 and 7.26 ±0. 12 and 7.30 ±0. 11; p = 0.0236, respectively). In monochorionic diamniotic twins with asymmetric growth, the second twin achieved significantly lower outcome than the first twin. Vaginal delivery was a predictive factor for a lower Apgar score and lower values of umbilical arterial blood pH in second twins, while not in first twins. Symmetrical fetal growth of twins was a predictive factor for better postnatal condition for both twins. Conclusions. In twin pregnancies, VD, but not CS, is associated with increased risk of worse postnatal condition of the second twin. In monochorionic diamniotic pregnancies complicated by growth discordance, CS seems to be a reasonable mode of delivery.

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Twin vaginal delivery is associated with lower umbilical arterial blood pH of the second twin and less intrapartum blood loss

Cited by 5 publications

References 14 publications

Trends in Caesarean section rates for twin pregnancies: a 20-year cohort study

Trends in Caesarean section rates for twin pregnancies: a 20-year cohort study

Experience in different modes of delivery in twin pregnancy

Postnatal condition of the second twin in respect to mode of delivery, chorionicity and type of fetal growth

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