Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-6bf8c574d5-9nwgx Total loading time: 0 Render date: 2025-02-22T07:22:13.630Z Has data issue: false hasContentIssue false

Chapter 25 - Practical Management of Vaginal Delivery in Multiple Pregnancy

Published online by Cambridge University Press:  11 October 2022

By
Julian N. Robinson
Edited by
Leanne Bricker ,
Julian N. Robinson  and
Baskaran Thilaganathan
Leanne Bricker
Affiliation:
Corniche Hospital, Abu Dhabi
Julian N. Robinson
Affiliation:
Brigham & Women's Hospital, Boston
Baskaran Thilaganathan
Affiliation:
St George's Hospital Medical School, University of London
Get access

Summary

Over the last 30 years there has been a gradual decrease in the vaginal delivery of twins. This may have led to a loss of obstetric intrapartum skills and confidence in some accoucheurs. Leading professional organizations recommend that all women with a cephalic presenting twin be counseled about the availability and safety of vaginal delivery. There are a number of different techniques for delivering twins and the accoucheur should be adept at all, and tailor their practice to the clinical situation in the moment, rather than relying on a single technique. Techniques for vaginal birth in multiple pregnancy have evolved in an anecdotal fashion and there is wide variation in practice throughout the world. None of the techniques are a challenge to a person of average dexterity and an Obstetrics department can safely increase the rate of vaginal delivery of twins through a program of needs assessment, education, simulation, and clinical backup. Some still advocate for the vaginal delivery of triplets, but such practice is rare and as a consequence questionable. The delivery of quadruplets and greater is by caesarean delivery.

Type
Chapter
Information
Management of Multiple Pregnancies
A Practical Guide
 , pp. 259 - 269
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Caughey, AB, Cahill, AG, Guise, JM et al. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol 2014;210:179–93.Google Scholar
Gibson, JL, Castleman, JS, Meher, S, Kilby, MD. Updated guidance for the management of twin and triplet pregnancies from the National Institute for Health and Care Excellence guidance, UK: what’s new that may improve perinatal outcomes? Acta Obstet Gynecol Scand 2020;99:147–52.CrossRefGoogle ScholarPubMed
Leftwich, HK, Zaki, MN, Wilkins, I, Hibbard, JU. Labor patterns in twin gestations. Am J Obstet Gynecol 2013 Sep;209(3):254.e1–5.CrossRefGoogle ScholarPubMed
Peaceman, AL, Kuo, L, Feinglass, J. Infant morbidity and mortality associated with vaginal delivery in twin gestations. Am J Obstet Gynecol 2009;200:462 e1–6.CrossRefGoogle ScholarPubMed
Houlihan, C, Knuppel, RA. Intrapartum management of multiple gestations. Clin Perinatol 1996;23:91–116.CrossRefGoogle ScholarPubMed
Cheng, M, Hannah, M. Breech delivery at term: a critical review of the literature. Obstet Gynecol 1993 Oct;82(4 Pt 1):605–18.Google Scholar
Blickstein, I, Goldman, RD, Kuofermic, M. Delivery of breech first twins: a multicenter retrospective study. Obstet Gynecol 2000;95:37–42.Google ScholarPubMed
Korb, D, Goffinet, F, Bretelle, F et al. First twin in breech presentation and neonatal mortality and morbidity according to planned mode of delivery. Obstet Gynecol 2020 May;135(5):1015–23. https://doi.org/10.1097/AOG.0000000000003785CrossRefGoogle ScholarPubMed
Alran, S, Sibony, O, Lutun, D et al. Maternal and neonatal outcome of 93 consecutive triplet deliveries with 71% vaginal delivery. Acta Obstet Gynecol Scand 2004;83:554–9.Google Scholar
Lappen, JR, Hackney, DN, Bailit, JL. Maternal and neonatal outcomes of attempted vaginal compared with planned cesarean delivery in triplet gestations. Am J Obstet Gynecol 2016;215:493e 1–6.CrossRefGoogle ScholarPubMed
Peress, D, Dude, A, Peaceman, A, Yee, LM. Maternal and neonatal outcomes in triplet gestations by trial of labor versus planned cesarean delivery. J Matern Fet Neonatal Med 2019;32:1874–9.Google ScholarPubMed
Machtinger, R, Sivan, E, Maayan-Metzger, A, Moran, O, Kuint, J, Schiff, E. Perinatal, postnatal, and maternal outcome parameters of triplet pregnancy according to the planned mode of delivery: results of a single tertiary center. J Matern Fetal Neonatal Med 2011;24:91–5.CrossRefGoogle Scholar
Vintzileos, AM, Ananth, CV, Kontopoulos, E, Smulian, JC. Mode of delivery and risk of stillbirth and infant mortality in triplet gestations: United States, 1995 through 1998. Am J Obstet Gynecol 2005;192:464–9.CrossRefGoogle ScholarPubMed
Mol, BW, Bergenhenegouwen, L, Velzel, J et al. Perinatal outcomes according to the mode of delivery in women with a triplet pregnancy in the Netherlands. J Matern Fetal Neonatal Med 2019;32:3771–7.CrossRefGoogle Scholar
Easter, SR, Gardner, R, Barrett, J, Robinson, JN, Carusi, D. Simulation to improve trainee knowledge and comfort with twin vaginal birth. Obstet Gynecol 2016;128:34s–39s.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×