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Neonatal Outcome of Second Twins Depending on Presentation and Mode of Delivery

Published online by Cambridge University Press:  21 February 2012

Vesna Bjelic-Radisic ,
Gunda Pristauz ,
Josef Haas ,
Albrecht Giuliani ,
Karl Tamussino ,
Arnim Bader ,
Uwe Lang  and
Dietmar Schlembach
Vesna Bjelic-Radisic*
Affiliation:
Department of Obstetrics and Gynecology, Medical University of Graz, Austria. [email protected]
Gunda Pristauz
Affiliation:
Department of Obstetrics and Gynecology, Medical University of Graz, Austria.
Josef Haas
Affiliation:
Department of Obstetrics and Gynecology, Medical University of Graz, Austria.
Albrecht Giuliani
Affiliation:
Department of Obstetrics and Gynecology, Medical University of Graz, Austria.
Karl Tamussino
Affiliation:
Department of Obstetrics and Gynecology, Medical University of Graz, Austria.
Arnim Bader
Affiliation:
Department of Obstetrics and Gynecology, Medical University of Graz, Austria.
Uwe Lang
Affiliation:
Department of Obstetrics and Gynecology, Medical University of Graz, Austria.
Dietmar Schlembach
Affiliation:
Department of Obstetrics and Gynecology, Medical University of Graz, Austria.
*
*Address for correspondence: Vesna Bjelic-Radisic, Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, A-8036 Graz, Austria.

Abstract

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Our objective was to examine the neonatal outcome of second twins depending on presentation and mode of delivery. Using a database we analyzed the short-term neonatal outcome in twin pregnancies offered a trial of labor with special emphasis on the second twin depending on presentation and mode of delivery. Neonatal outcome was evaluated by Apgar scores, umbilical cord blood pH values, and perinatal or neonatal morbidity and mortality. Overall, in 219 (78%) of 281 pregnancies successful vaginal birth (VB) of both twins (VB–VB) was possible, 48 (17%) women had to be delivered by cesarean section (CS) of both twins (CS–CS), and in 14 (5%) women the second twin had to be delivered by CS after VB of the first twin (VB–CS). Successful VB was most common for vertex-vertex (V/V; n = 171, 82%) and vertex-nonvertex (n = 48, 75%) presentation (V/NV). Twins delivered by VB–CS had the lowest values for pHart (p = .006) and pHven (p = .010). pHart less than or equal to 7.00 values occurred only in second twins delivered VB–VB or VB–CS. Lower Apgar scores of the second twin occurred more frequently in the VB–CS and in the VB–VB than in the CS–CS groups (ps < .05). Lower levels of pHart (p = .002) and frequency of pHart less than or equal to 7.00 occurred more often in nonvertex second twins than in vertex second twins (p < .022). The high CS rate in V/NV presentation and the significantly worse perinatal short-term outcome of NV second twins after VB of the first twin underline that randomized studies are necessary to evaluate the best delivery mode for V/NV twins.

Type
Articles
Information
Twin Research and Human Genetics , Volume 10 , Issue 3 , 01 June 2007 , pp. 521 - 527
Copyright
Copyright © Cambridge University Press 2007