Risk factors for cesarean delivery and adverse neonatal outcome in twin pregnancies attempting vaginal delivery

Natali Schachter-Safrai, Gilad Karavani*, Rani Haj-Yahya, Noa Ofek Shlomai, Shay Porat

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Introduction: Twin vaginal delivery presents a unique clinical challenge for obstetricians. The Twin Birth Study demonstrated the safety of planned vaginal delivery regarding neonatal outcomes. However, that study lacked a description of the risk factors associated with and the outcome of unplanned cesarean section. The aim of this study is to identify potential risk factors for cesarean section and delivery related neonatal morbidity and mortality in women with twin pregnancy attempting vaginal delivery. Material and methods: A retrospective cohort study including 1070 women with twin pregnancy that underwent a trial of labor between 2003 and 2015. The study population was divided according to the mode of delivery: vaginal delivery, combined vaginal-cesarean and intrapartum cesarean delivery of both twins. Several risk factors and neonatal outcomes were examined by both univariate analysis and multinomial logistic regression analysis. Results: The rate of vaginal delivery of both twins was 88.3%, whereas the rates of combined vaginal cesarean and unplanned cesarean delivery were 4.6% and 7.1%, respectively. Nulliparity and nonvertex presentation of twin B were found to be independently associated with cesarean delivery for both twins. Additionally, nonvertex presentation of twin B was independently associated with combined vaginal-cesarean delivery. The proportion of neonates with Apgar score <7 at 5 min was increased for both twins in the combined vaginal-cesarean group compared with those delivered by the vaginal route alone. Conclusion: Nulliparity and nonvertex presentation of twin B were found to be associated with intrapartum cesarean delivery in twin pregnancies.

Original languageAmerican English
Pages (from-to)845-851
Number of pages7
JournalActa Obstetricia et Gynecologica Scandinavica
Volume97
Issue number7
DOIs
StatePublished - Jul 2018
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2018 Nordic Federation of Societies of Obstetrics and Gynecology

Keywords

  • Nonvertex presentation
  • nulliparity
  • twins
  • unplanned cesarean delivery
  • weight discordancy

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