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Delivery of the second twin.

N A Ginsberg1, E M Levine

  • 1Northwestern University Medical School, Chicago, IL, USA. cvsguy1@aol.com

International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics
|October 19, 2005
PubMed
Summary

Cesarean delivery for the second twin after vaginal birth of the first twin occurred in 10.1% of cases. Cesarean delivery reduced low Apgar scores in neonates under 2000 grams.

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Area of Science:

  • Obstetrics
  • Perinatology
  • Maternal-Fetal Medicine

Background:

  • Vaginal delivery of the second twin after the first twin's vaginal birth presents unique clinical challenges.
  • Understanding the risks associated with different delivery scenarios is crucial for optimizing perinatal outcomes.

Purpose of the Study:

  • To assess the rate of cesarean delivery for the second twin following a vaginal delivery of the first twin.
  • To evaluate the risk of vaginal delivery failure for the second twin.
  • To examine the impact of delivery mode on neonatal outcomes, specifically Apgar scores.

Main Methods:

  • Retrospective analysis of 10,365 twin pairs (20,730 births) from Illinois birth certificate data (1997-2000).
  • Focus on deliveries where the first twin was vaginally delivered.

Main Results:

  • Cesarean delivery for the second twin occurred in 10.1% of cases.
  • The highest incidence of failed vaginal delivery for the second twin was observed in the vertex/non-vertex presentation group.
  • Vaginally delivered twins weighing less than 2000 grams had significantly higher rates of 5-minute Apgar scores below 4 compared to those delivered via cesarean (p<0.001).

Conclusions:

  • Twin presentation type is a significant predictor of successful vaginal delivery for the second twin.
  • Cesarean delivery appears to reduce the incidence of low Apgar scores in neonates weighing less than 2000 grams.

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