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Twin vaginal birth after cesarean
1University of Connecticut School of Medicine, Department of Obstetrics and Gynecology, USA.
Connecticut Medicine
|May 17, 2000
Summary
Vaginal birth after cesarean for twins is successful. However, the second twin born may require a longer neonatal intensive care unit (NICU) stay.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Perinatology
Background:
- Vaginal birth after cesarean (VBAC) is a common consideration in singleton pregnancies.
- The safety and success rates of VBAC in twin gestations are less established.
- Twin gestations present unique challenges for labor and delivery management.
Purpose of the Study:
- To evaluate the success rate of vaginal delivery for twin gestations with a prior cesarean.
- To assess maternal and fetal outcomes in women attempting VBAC for twins.
- To compare outcomes between women attempting VBAC for twins and those attempting vaginal delivery without a prior cesarean.
Main Methods:
- A retrospective case-control study was conducted at a single center from 1988-1998.
- Women attempting VBAC for twins were matched with controls attempting vaginal delivery without prior cesarean.
- Exclusion criteria included early gestation, monoamnionicity, non-vertex twin A, or fetal anomalies/death.
Main Results:
- The success rate for vaginal delivery of both twins after cesarean was high (10/12 women).
- No significant differences were observed in maternal morbidity or postpartum stay between groups.
- Second-born twins in the VBAC group had significantly longer neonatal intensive care unit (NICU) stays.
Conclusions:
- Twin trial of labor after cesarean (TOLAC) demonstrates a high success rate for vaginal delivery.
- While maternal outcomes are comparable, a longer NICU stay for the second twin may be associated with TOLAC in twin gestations.
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