scholarly journals Retrospective evaluation of attempted vaginal deliveries in dichorionic twin pregnancies

2020 ◽  
Author(s):  
Sabine Enengl ◽  
Peter Oppelt ◽  
Simon-Hermann Enzelsberger ◽  
Philip Sebastian Trautner ◽  
Omar Shebl ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Vaginal Delivery ◽  
Time Interval ◽  
Apgar Scores ◽  
Outcome Parameters ◽  
Retrospective Data Analysis ◽  
Vaginal Deliveries ◽  
Mode Of Birth ◽  
Twin Pregnancies ◽  
Second Twin

Abstract Purpose Numbers of planned cesarean deliveries are increasing in twin pregnancies, despite the lack of evidence for this approach, and the second twin is thought to be at risk for a poorer outcome. The aim of this study was to examine whether twins have a poorer outcome if an attempted vaginal delivery is changed to a cesarean section or combined delivery. Methods This retrospective data analysis included all women with dichorionic twin pregnancies attempting vaginal delivery over a 10-year period. Outcome parameters for the first and second twins relative to their mode of birth were compared. A correlation model between the interdelivery time interval and Apgar scores was calculated. Subgroup analyses assessing the birth mode of the first and second twins were conducted. Results A total of 248 women were enrolled in the study. The second twins had significantly lower values for outcome parameters, such as umbilical artery cord pH and Apgar scores in comparison with the first twins (P < 0.01). The subgroup analysis of birth modes in first and second twins showed a significantly poorer outcome in the cesarean section and combined delivery group (P < 0.05). The interdelivery time interval was significantly longer in the second twin cesarean section group (P < 0.01). There was no significant correlation between the interdelivery time intervals and Apgar scores (P > 0.05). Conclusion Although outcome parameters were significantly lower in second twins and twins born via secondary cesarean section, the clinical relevance of this appears to be negligible.

scholarly journals Delivery of Twin Gestation (≥ 32.0 Weeks): The Vaginal Route as a Practicable and Safe Alternative to Cesarean Section

2020 ◽  
Vol 80 (10) ◽  
pp. 1033-1040
Author(s):  
Anne Dathan-Stumpf ◽  
Katharina Winkel ◽  
Holger Stepan
Keyword(s):  
Cesarean Section ◽  
Vaginal Delivery ◽  
Neonatal Outcome ◽  
Neonatal Outcomes ◽  
University Hospital ◽  
Delivery Mode ◽  
Safe Alternative ◽  
Vaginal Deliveries ◽  
Twin Pregnancies ◽  
Second Twin

Abstract Objective The appropriate delivery mode for twins is discussed controversially in the literature. The aim of this study was to investigate delivery modes and short-term neonatal outcomes of twin pregnancies delivered in University Hospital Leipzig. Material and Methods A total of 274 twin pregnancies (32.0 to 39.4 weeks of gestation) delivered between 2015 and 2017 were analyzed retrospectively with regard to the planned and final delivery mode as well as neonatal outcomes. The inclusion and exclusion criteria for vaginal delivery were comparable to those of the Twin Birth Study. Results The spontaneous birth rate for births planned as vaginal deliveries was 78.5%; the rate of secondary cesarean section was 19.4%. The final total cesarean rate was 58.8%, and the rate of vaginal deliveries was 41.2%. Vertex or non-vertex position of the second twin had no significant effect on neonatal outcome or mean delivery interval between the birth of the first and second twin. Chorionicity, neonatal weight and gender had no significant impact on delivery mode. However, successful vaginal delivery was associated with higher gestational age and both fetuses in vertex position. The combined neonatal outcome for both twins was significantly worse if they were delivered by cesarean section compared to spontaneous birth. In addition, the leading twin in monochorionic/diamniotic (MC/DA) pregnancies was intubated more frequently after cesarean delivery and had significantly lower Apgar scores. Conclusion Vaginal delivery in twin pregnancies is a practicable and safe option in specific defined conditions and when the appropriate infrastructure and clinical experience is available.

scholarly journals Anandamide Exerts a Differential Effect on Human Placenta Before and After the Onset of Labor

2021 ◽  
Vol 12 ◽  
Author(s):  
Paula Accialini ◽  
Cyntia Abán ◽  
Tomás Etcheverry ◽  
Mercedes Negri Malbrán ◽  
Gustavo Leguizamón ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Vaginal Delivery ◽  
Endocannabinoid System ◽  
Cesarean Sections ◽  
Vaginal Deliveries ◽  
Before And After ◽  
Elective Cesarean ◽  
Main Components ◽  
Relevant Finding

The onset of labor involves the action of multiple factors and recent reports have postulated the endocannabinoid system as a new regulator of this process. Our objective was to study the role of anandamide, one of the main endocannabinoids, on the regulation of placental molecules that contribute to the onset of labor at term. Placental samples were obtained from patients with laboring vaginal deliveries and from non-laboring elective cesarean sections. Vaginal delivery placentas produced higher prostaglandins levels than cesarean section samples. Besides, no differences were observed in NOS basal activity between groups. Incubation of vaginal delivery placentas with anandamide increased prostaglandins concentration and decreased NOS activity. Antagonism of type-1cannabinoid receptor (CB1) did not alter the effect observed on NOS activity. Conversely, incubation of cesarean section placentas with anandamide reduced prostaglandins levels and enhanced NOS activity, the latter involving the participation of CB1. Furthermore, we observed a differential expression of the main components of the endocannabinoid system between placental samples, being the change in CB1 localization the most relevant finding. Our results suggest that anandamide acts as a modulator of the signals that regulate labor, exerting differential actions depending on CB1 localization in laboring or non-laboring term placentas.

scholarly journals Effect of Chorionicity on Umbilical Cord Blood Acid-Base Analysis of the Second Twin

2020 ◽  
Vol 23 (3) ◽  
pp. 178-183
Author(s):  
Matthew J. Blitz ◽  
Burton Rochelson ◽  
Nontawan Benja-Athonsirikul ◽  
Weiwei Shan ◽  
Meir Greenberg ◽  
...  
Keyword(s):  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Tertiary Hospital ◽  
Chronic Hypertension ◽  
Acid Base ◽  
Arterial Ph ◽  
Vaginal Deliveries ◽  
Twin Pregnancies ◽  
Second Twin

AbstractOur objective was to determine whether chorionicity affects umbilical cord blood acid-base parameters of the second twin. This was a retrospective cohort of twin pregnancies delivered at ≥23 weeks of gestation at a tertiary hospital from 2010 to 2016. Patients were included if arterial and venous umbilical cord gas results were available for both newborns and chorionicity was confirmed histologically. Exclusion criteria included intrauterine fetal demise of either twin prior to labor, major fetal anomalies, monoamnionicity, uncertain chronicity and twin-to-twin transfusion syndrome. The primary outcome evaluated was the umbilical artery (UA) pH of the second twin. A total of 593 dichorionic (DC) and 86 monochorionic (MC) twin pregnancies were included. No difference in UA pH was observed between MC and DC twins. Among vaginal deliveries (n = 97), the UA pH of the first twin was higher than the second twin (7.26 vs. 7.24; p = .01). Twin-to-twin delivery interval (TTDI) ≥20 min was associated with a higher UA pH in the first twin compared to the second twin (7.25 vs. 7.16, respectively; p = .006). Multivariable logistic regression was used to predict arterial pH < 7.20 for the second twin; the most predictive factors were arterial pH < 7.20 for the first twin, chronic hypertension and prolonged TTDI. Chorionicity was not associated with any acid-base parameter of umbilical cord blood in either the first or second twin. No differences in neonatal outcomes were observed based on chorionicity or birth order. Populations with a lower cesarean delivery rate may yield different findings.

Timing and Safety of Postpartum Enoxparin.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4110-4110
Author(s):  
Rachel A. Freedman ◽  
Jeffrey Zwicker ◽  
Kenneth Alan Bauer
Keyword(s):  
Cesarean Section ◽  
Vaginal Delivery ◽  
Postpartum Hemorrhage ◽  
Postpartum Period ◽  
Retrospective Cohort ◽  
Low Molecular Weight Heparin ◽  
Control Group ◽  
Low Molecular Weight ◽  
Cesarean Sections ◽  
Vaginal Deliveries

Abstract The appropriate time to restart anticoagulation in the postpartum period is not known. Both the American College of Obstetrics and Gynecology as well as American College of Chest Physicians (ACCP) have issued guidelines regarding the use of anticoagulants during pregnancy but neither have generated recommendations regarding the timing of the first dose of low-molecular-weight heparin (LMWH) in the postpartum period. The incidence of postpartum hemorrhage was assessed in a retrospective cohort study of 95 women treated with enoxaparin and compared with 303 consecutive deliveries where anticoagulation was not administered. The rate of severe postpartum hemorrhage did not differ significantly for women treated with peripartum enoxaparin versus a control group of women undergoing vaginal delivery (3.6% versus 1.4%, P=0.72) or cesarean section (5.1% versus 3.4%, P=0.98). There were no severe postpartum hemorrhages following the re-initiation of enoxaparin postpartum. In 75% of vaginal deliveries and 49% of cesarean sections, enoxaparin was restarted within 24 hours. Two incisional hematomas were observed in the group of women who received enoxaparin within 24 hours following cesarean section. We conclude that severe postpartum hemorrhage is an infrequent complication following the administration of enoxaparin postpartum. In support of current clinical practice, enoxaparin can be safely administered 0 to 24 hours following vaginal delivery and 12 to 36 hours following cesarean section.

The Second Twin: Retained and Unretained

1995 ◽  
Vol 25 (3) ◽  
pp. 132-133 ◽  
Author(s):  
J I Brian Adinma ◽  
Andy O Agbai
Keyword(s):  
Mortality Rate ◽  
Perinatal Mortality ◽  
Early Recognition ◽  
Remedial Measures ◽  
Apgar Scores ◽  
Perinatal Mortality Rate ◽  
Uterine Inertia ◽  
Comparative Review ◽  
Twin Pregnancies ◽  
Second Twin

In this comparative review of retained and unretained second twins, the commonest causes of retention of the second twins were found to be uterine inertia (48.4%) and obstruction from malpresentation and malposition (32.3%). The pair-presentation most likely to be retained was vertex/transverse. Apgar scores were lower for retained than unretained second twins. The perinatal mortality rate was significantly higher for the retained second twins (258/1000) compared to the unretained second twins (60.2/1000) ( P < 0.002). Early recognition of twin pregnancies in which the 2nd twin is more likely to be retained, and prompt application of appropriate remedial measures would reduce the incidence of retention of the second twin.

scholarly journals Clinical Study on Different Delivery Methods of Twin Pregnancy

2021 ◽  
Author(s):  
Liyan Hu
Keyword(s):  
Cesarean Section ◽  
Pregnancy Outcome ◽  
Vaginal Delivery ◽  
Twin Pregnancy ◽  
Delivery Methods ◽  
Preterm Premature Rupture ◽  
Key Points ◽  
Baseline Information ◽  
The Difference ◽  
Twin Pregnancies

Objective To investigate the effect of different methods of delivery on the outcome of twin pregnancies. Methods This is a retrospective cohort review of 627 twin pregnancies with delivery from January 2016 to December 2019. According to the clinical guidelines for cesarean section, the cesarean section and vaginal delivery groups were determined. Finally, the baseline information, delivery method, pregnancy outcome, and maternal and infant complications of the two groups were compared. Results For different delivery methods, the incidence of preeclampsia was significantly higher in the cesarean section group than in the vaginal delivery group (χ2 = 4.405, p < 0.05). There were 23 fetal growth ratios (FGR) in the cesarean section group, which were significantly higher than the vaginal delivery group (χ2 = 4.740, p < 0.05). However, the incidence of preterm premature rupture of membranes (PPROM) in the vaginal delivery group was significantly higher than in the cesarean section group (χ2 = 5.235, p < 0.05). In addition, the volume of postpartum bleeding in the vaginal delivery group was significantly higher than in the cesarean section group (t = 4.723, p < 0.001). The neonatal weights and 5-minute Apgar scores of the vaginal delivery group were lower than the cesarean section group, and the difference was statistically significant. In the vaginal delivery group, 48 and 26 neonates were transferred to the intensive care and neonatal units, respectively, which were significantly higher than in the cesarean section group (χ2 = 5.001, p < 0.05). Conclusion The major complications of a twin pregnancy are gestational diabetes mellitus and PPROM. Cesarean section can reduce the rate of neonatal asphyxia in twins and improve the pregnancy outcome. Key Points

scholarly journals Obstetric and Neonatal Outcome in Second-Pregnancy Patients with One Prior Cesarean Section at A Costarican Hospital 2006-2007

2011 ◽  
Vol 52 (1) ◽  
Author(s):  
Manrique Leal Mateos ◽  
Loretta Giacomin Carmiol ◽  
Rafael A Moya Sibaja
Keyword(s):  
Cesarean Section ◽  
Vaginal Delivery ◽  
Neonatal Resuscitation ◽  
Obstetric Complications ◽  
Obstetric Outcomes ◽  
Maternal Complications ◽  
Cross Sectional ◽  
Neonatal Complications ◽  
Vaginal Deliveries ◽  
Prior Cesarean Section

Aim: To analyze neonatal and obstetric outcomes in second-pregnancy patients with 1 prior cesarean section.Materials and methods: This study is a cross-sectional observational study. We analyzed 306 medical records of patients treated at the Dr. Rafael A. Calderón Guardia Hospital (HCG), from January 1st 2006 to December 31st of 2007. Maternal variables associated to prenatal control were age and obstetrical indication of the previous cesarean delivery. Variables associated to delivery were gestational age, type of delivery, obstetric complications, and length of hospital stay. The neonatal variables were weight at birth, 5 minute Apgar score, neonatal complications, need for neonatal resuscitation or newborn hospitalization and length of hospital stay.Results: 59, 1% of the patients with 1 prior cesarean section had successful vaginal delivery. The percentage of maternal complications was significantly higher for those who underwent a cesarean section during labor.Uterine rupture occurred in 1,3% of the cases and no maternal or neonatal deaths were found as a consequence of such complication. The percentage of neonatal complications was similar for both groups. The need for neonatal resuscitation was significantly higher in the group that underwent an elective caesarean delivery.Conclusion: Our results show that at the HCG from January 1st 2006 to December 31st of 2007, a vaginal delivery in second-pregnancy patients with 1 prior caesarean delivery appears to be safe. The percentage of successful vaginal deliveries, obstetric complications and uterine rupture were similar to those reported in international literature. 

scholarly journals Twin Deliveries: The Prevalence and Perinatal Outcomes in Public Hospitals in Dar es Salaam City, Tanzania

2020 ◽  
Author(s):  
Zavery Benela ◽  
Alfred Chibwae ◽  
Ola Jahanpour ◽  
Dismas Matovelo
Keyword(s):  
Perinatal Mortality ◽  
Vaginal Delivery ◽  
Apgar Score ◽  
Dar Es Salaam ◽  
Public Hospitals ◽  
Active Management ◽  
P Value ◽  
Major Mode ◽  
Twin Pregnancies ◽  
Second Twin

Abstract Background The perinatal mortality rates are five times higher in twin pregnancies than singleton pregnancies, therefore antenatal management and safe delivery of twin pregnancies are important issues in obstetrics. This study aimed at providing data on the proportion of twin deliveries in four public hospitals in Dar es Salaam and an insight on the fetal outcomes in relation to their modes of delivery. Methods This was a cross sectional study in which all women who delivered twin babies were interviewed and medical records on their delivery summary were obtained in the labour and post-natal wards in four public hospitals in Dar es Salaam between July and December 2011. Post-natal follow up was done on seventh day by contacting women by telephone to establish the neonatal status. Results There were 33,638 total deliveries of which 672 were twin deliveries making the prevalence of 2.0% (20 per 1,000 births). Of all twin deliveries analyzed (666 pairs), 373(56.0%) had the diagnosis of twin pregnancy made antenatally. Vaginal delivery was the major mode of delivery (77.3%). whereas combined delivery in which the first twin was delivered vaginally and the second twin by caesarian section accounted for only 2.6%. At birth 1252(94%) of twins were alive, 60(4.5%), were fresh stillbirths and 20(1.5%) were macerated stillbirths. Low Apgar score was more to first twins delivered vaginally compared to first twins (p-value=0.003). Low Apgar score (AS <7) was more amongst second twins delivered vaginally at 30 minutes or longer 27(48.2%) compared to twins delivered in less than 30 minutes 72(15.4%), (p-value=0.001). Conclusion There was a significant association between vaginal delivery and low Apgar score at one minute. Long duration of twin to twin delivery interval was associated with low Apgar score of the second twins delivered vaginally. Perinatal mortality rate was also higher in the second twins compared to the first twins. The time delivery interval of the second twin should be made as short as possible by active management of all second twins. Neonatal facilities are required in all hospitals conducting twin deliveries to care for premature babies.

scholarly journals Incidence and Risk Factors of Postpartum Hemorrhage in China: A Multicenter Retrospective Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Sijian Li ◽  
Jinsong Gao ◽  
Juntao Liu ◽  
Jing Hu ◽  
Xiaoxu Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Cesarean Section ◽  
Subgroup Analysis ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Mode Of Delivery ◽  
Predictive Performance ◽  
Vaginal Deliveries ◽  
Twin Pregnancies

Background: Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide but the incidence and its risk factors in China is limited. The objective of this study is to investigate the incidence and the risk factors of PPH in Chinese women.Methods: A multi-center retrospective study of pregnant women at ≥28 weeks of gestation was conducted. Logistic regression was used to identify potential risk factors of PPH and receiver operating characteristic curve was used to evaluate the predictive performance of the identified risk factors. Subgroup analysis focusing on the number of fetus and the mode of delivery was conducted.Results: A total of 99,253 pregnant women were enrolled and 804 (0.81%) experienced PPH. The subgroup analysis revealed that the incidence of PPH was 0.75, 2.65, 1.40, and 0.31% in singletons, twin pregnancies, cesarean sections, and vaginal deliveries, respectively. Placenta previa and placenta accreta were the predominant risk factors of PPH in the overall population and all subgroups. A twin pregnancy was a risk factor for PPH regardless of the mode of delivery. Obesity, and multiparity were risk factors for PPH in both singletons and cesarean section cases, but the latter predicted a reduced probability of PPH in vaginal deliveries. Macrosomia was associated with increased risk of PPH in singletons or vaginal deliveries. In women who delivered vaginally, preeclampsia was associated with a higher risk of PPH. The areas under the curve for the overall cohort, singletons, twin pregnancies, cesarean section cases, and vaginal deliveries were 0.832 (95% confidence interval [CI] 0.813–0.851), 0.824 (95% CI 0.803–0.845), 0.686 (95% CI 0.617–0.755), 0.854 (95% CI 0.834–0.874), and 0.690 (95% CI 0.646–0.735), respectively.Conclusions: The risk factors of PPH varied slightly based on the number of fetuses and the mode of delivery, while placenta previa and placenta accreta were the two major risk factors. A combination of the identified risk factors yielded a satisfactory predictive performance in determining PPH in the overall cohort, singletons pregnancies, and women who delivered by cesarean section, whereas the performance was moderate in twin pregnancies and in women delivering vaginally.

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