Total breech extraction of the second twin in trial of labor after cesarean

AbstractThe aim of this study was to compare maternal and neonatal outcome of twin births according to mode of delivery and to isolate the factors predicting a successful vaginal delivery and those predicting a failed trial of labor (TOL) leading to an emergent cesarean section. We reviewed all twin deliveries during the years 1995 to 2004. Parameters studied include maternal age, parity, gestational age, maternal antepartum complications and postpartum complications, fetal presentations, birthweight, mode of delivery of each twin, Apgar scores and cord pH. During the study period there were 40,710 deliveries of which 804 (1.9%) were twin deliveries. Of the 804 twins, 398 (49.5%) had planned cesarean sections (PCS) and 406 (50.5%) entered a TOL. Maternal age and parity were similar among the groups. Neonatal outcomes and postpartum complications did not differ between the groups. Of 406 women who had a TOL, 84.9% eventually delivered both twins vaginally. A significantly higher percentage of antepartum complications were noted among those who failed the TOL compared to those with successful TOL (8.2% vs. 1.7%, p =.01). The number of neonates with pH of less than 7.0 did not differ between the groups although more neonates (2.5% vs. 0.4%, p =.05) among the failed TOL had an Apgar score of less than 7.0 at 5 minutes compared to successful TOL. Vaginal delivery of both twins after TOL occurred in 91% of vertex/vertex compared with 71.8% of vertex/nonvertex presenting twins ( p < .01). Neonatal outcomes did not differ between both groups. Our results indicate that both vaginal and PCS are comparable options for vertex presenting first twin regardless of second twin presentation.

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OVARIAN CYST FORMATION: MANY YEARS AFTER HYSTERECTOMY FOR HEMORRHAGIC COMPLICATIONS IN TWIN DELIVERY

Journal of Nepal Medical Association ◽

10.31729/jnma.478 ◽

2004 ◽

Vol 43 (153) ◽

Author(s):

Saraswati Padhye ◽

C Karki

Keyword(s):

Ovarian Cyst ◽

Postpartum Hemorrhage ◽

Wedge Resection ◽

Cyst Formation ◽

Subtotal Hysterectomy ◽

Hemorrhagic Complications ◽

Twin Delivery ◽

Breech Extraction ◽

Second Twin

After a subtotal hysterectomy for severe postpartum hemorrhage due to rupture uterus, followingcomplication at internal podalic version and breech extraction for a second twin, in a primipara; a longterm follow up and management by a wedge resection of ovary, ovariotomy, and removal of cyst was carriedout by the same surgeon in three different Hospitals, so unique in our context, is reported.Key Words: TwinDelivery, Internal Podalic Version.

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Disparities in Trial of Labor among Women with Twin Gestations in the United States

American Journal of Perinatology ◽

10.1055/s-0041-1727228 ◽

2021 ◽

Author(s):

Gina N. Mo ◽

Yvonne W. Cheng ◽

Aaron B. Caughey ◽

Lynn M. Yee

Keyword(s):

United States ◽

Vaginal Delivery ◽

Maternal Age ◽

Demographic Factors ◽

The United States ◽

Clinical Factors ◽

Factors Associated ◽

Trial Of Labor ◽

Hispanic White ◽

Second Twin

Objective The aim of the study is to examine clinical and demographic factors associated with trial of labor (TOL) among women with twin gestations eligible for a vaginal delivery. Study Design This was a population-based cohort study of women giving birth to twin gestations in the United States (2012–2014). Inclusion criteria for the analysis included live births greater than 23 weeks' gestation and a cephalic presenting twin. Women with prior cesarean delivery were excluded. Women were categorized by whether they underwent a TOL. Clinical and demographic characteristics associated with TOL status were evaluated using multivariable logistic regression analyses. Secondary analyses with stratification by parity and by second twin presentation were performed. Results Of 90,000 women eligible for inclusion, a minority (39.3%) underwent TOL. Women who had a greater gestational age at delivery were more likely to have a TOL. In contrast, several demographic factors were associated with decreased likelihood of TOL, including maternal age >35 years and identifying as Hispanic or Asian compared with non-Hispanic White. No differences in odds of TOL were observed for women who were identified as non-Hispanic Black versus non-Hispanic White, nor were other demographic factors such as marital status, insurance status, or educational attainment associated with undergoing TOL. Clinical factors associated with decreased odds of TOL included nulliparity, obesity, and hypertensive disorders of pregnancy. Results did not substantively change when stratified by parity or second twin presentation, nor did findings differ in the subgroup who delivered at 32 weeks of gestation or greater. Conclusion In this large population of women with twins who were eligible for a TOL, a minority of individuals attempted a vaginal delivery. Demographic and clinical factors such as older maternal age, Asian or Hispanic racial or ethnic identification, nulliparity, and obesity are associated with decreased odds of undergoing TOL. Key Points

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

Twin Research and Human Genetics ◽

10.1375/twin.10.3.521 ◽

2007 ◽

Vol 10 (3) ◽

pp. 521-527 ◽

Cited By ~ 10

Author(s):

Vesna Bjelic-Radisic ◽

Gunda Pristauz ◽

Josef Haas ◽

Albrecht Giuliani ◽

Karl Tamussino ◽

...

Keyword(s):

Neonatal Outcome ◽

Mode Of Delivery ◽

Neonatal Morbidity ◽

Delivery Mode ◽

Short Term ◽

Term Outcome ◽

Apgar Scores ◽

Trial Of Labor ◽

Twin Pregnancies ◽

Second Twin

AbstractOur 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.

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