Article

Prediction of safe and successful vaginal twin birth

Royal College of Surgeons in Ireland, Dublin, Ireland.
American journal of obstetrics and gynecology (Impact Factor: 3.97). 05/2011; 205(3):237.e1-7. DOI: 10.1016/j.ajog.2011.05.033
Source: PubMed

ABSTRACT The objective of the study was to establish predictors of vaginal twin birth and evaluate perinatal morbidity according to mode of delivery.
One thousand twenty-eight twin pregnancies were prospectively recruited. For this prespecified secondary analysis, obstetric characteristics and a composite of adverse perinatal outcome were compared according to the success or failure of a trial of labor and further compared with those undergoing elective cesarean delivery. Perinatal outcomes were adjusted for chorionicity and gestational age using a linear model for continuous data and logistic regression for binary data.
Nine hundred seventy-one twin pregnancies met the criteria for inclusion. A trial of labor was considered for 441 (45%) and was successful in 338 of 441 (77%). The cesarean delivery rate for the second twin was 4% (14 of 351). Multiparity and spontaneous conception predicted vaginal birth. No statistically significant differences in perinatal morbidity were observed.
A high prospect of successful and safe vaginal delivery can be achieved with trial of twin labor.

0 Followers
 · 
115 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Objective: We aimed to characterize risk factors for combined twin delivery and assess neonatal outcome. Methods: This was a retrospective cohort study of all women admitted for trial of labor (TOL) with twin gestation, in a single, tertiary, university-affiliated medical center. Eligibility was limited to gestations with twin A delivered vaginally. Results: During the study period, 44,263 women delivered in our center, of whom 1,307 (2.9%) delivered twins. Overall, 221 out of 247 women (89.5%) undergoing TOL delivered twin A vaginally. Parturients who delivered twin B by cesarean delivery (n=23) were compared with those delivered twin B vaginally (n=198). Multivariate analysis demonstrated that risk factors combined delivery were included non-cephalic twin B at admission (aOR 11.5, 95% CI 3.8-34.9, p<0.001) or after delivery of twin A (aOR 17.7, 95% CI 6.6-47.2, p<0.001), and dichorionic-diamniotic twins (aOR 8.9, 95% CI 1.8-44.0, p=0.008). Spontaneous version of a cephalic twin B was not found to increase the risk (above the baseline risk of non-cephalic twin B) for combined delivery. Combined delivery was associated with slightly higher risk for hemorrhagic-ischemic encephalopathy of twin B (4.3% vs. 0%, p=0.003). Conclusion: Non-cephalic twin B at admission or following delivery of twin A poses higher risk for combined delivery. Neonatal outcome of twin B following combined delivery are comparable with those of vaginal delivery.
    Journal of Maternal-Fetal and Neonatal Medicine 05/2014; DOI:10.3109/14767058.2014.927430 · 1.21 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Sonographic estimation of fetal weight (EFW) is important in the management of high-risk pregnancies. The possibility that increased maternal body mass index (BMI) adversely affects EFW assessments in twin pregnancies is controversial. The aim of this study was to investigate the effect of maternal BMI on the accuracy of EFW assessments in twin gestations prospectively recruited for the ESPRiT (Evaluation of Sonographic Predictors of Restricted growth In Twins) study. 1001 twin pair pregnancies were recruited. After exclusion, BMI, birthweights, and ultrasound determination of EFW (within 2 weeks of delivery) were available for 943 twin pairs. The accuracy of EFW determination was defined as the difference between EFW and actual birthweight for either twin (absolute difference and percent difference). Cells with < 5% of the population were combined for analysis resulting in the following three maternal categories: 1.Normal/Underweight; 2.Overweight; and 3.Obese/Extremely Obese. Analysis of the three categories revealed mean absolute variation values of 184 grams (8.0%) in the normal / underweight group (n=531), 196 grams (8.5%) in the overweight group (n=278) and 206 grams (8.6%) in the obese/ extremely obese group (n=134)(p-value = 0.028, non-significant after adjustment for multiple testing). Regression analysis showed no linear or log-linear relationship between BMI and the accuracy of EFW (p-value for absolute difference=0.11, p-value for percentage difference=0.27). Contrary to a commonly held clinical impression, increasing maternal BMI has no significant impact on the accuracy of EFW estimations in twin pregnancy.
    American journal of obstetrics and gynecology 11/2013; 210(4). DOI:10.1016/j.ajog.2013.11.010 · 3.97 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Objective: To compare the outcomes of twin pregnancies conceived by artificial reproductive techniques (ART) with those of spontaneous conception. Study design: In this multicenter prospective trial, comparisons were made between methods of conception in twin pregnancies, for maternal and perinatal outcomes. Results: Of 1001 twin pairs, 763/1001 (72.7%) were spontaneously conceived and 238/1001(27.3%) were conceived by ART. There were no significant differences between the two groups with respect to obstetric complications. There were 13 per 1000 (20/1504; 1%) perinatal deaths in the spontaneously conceived group and 6 per 1000 (3/466; 0.6%) in the ART group (p = 0.8141). We found no differences in gestational age at delivery (median 36.9 versus 37.0 weeks), birth weight (median 2520 g versus 2538 g), or in a composite measure of adverse perinatal outcome (17% versus 15%) between the groups. Conclusion: There were no differences in the rate of adverse obstetric or perinatal outcomes between twins conceived naturally compared with twins conceived by assisted conception.
    The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 07/2013; DOI:10.3109/14767058.2013.818653 · 1.21 Impact Factor