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External Cephalic Version: Is it an Effective and Safe Procedure?
08:49

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Published on: June 6, 2020

Cesarean delivery for the second twin.

James M Alexander1, Kenneth J Leveno, Dwight Rouse

  • 1Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75235-9032, USA. james.alexander@utsouthwestern.edu

Obstetrics and Gynecology
|October 2, 2008
PubMed
Summary
This summary is machine-generated.

Combined vaginal/cesarean delivery for twins may increase risks of endometritis and neonatal sepsis for the second twin. However, severe outcomes like hypoxic ischemic encephalopathy and death were not significantly affected by this delivery route.

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Area of Science:

  • Obstetrics and Gynecology
  • Neonatal Medicine
  • Perinatal Research

Background:

  • Twin gestations present unique delivery challenges.
  • Combined route delivery (vaginal/cesarean) for twins requires careful outcome assessment.
  • Understanding risks associated with sequential delivery modes is crucial for clinical practice.

Purpose of the Study:

  • To evaluate maternal and infant outcomes following a vaginal delivery of twin A and cesarean delivery of twin B.
  • To determine if the second twin experiences increased short-term morbidity in a combined route delivery scenario.

Main Methods:

  • Prospective cohort study of cesarean deliveries across 13 university centers (1999-2000).
  • Secondary analysis focused on twin gestations undergoing labor and cesarean delivery.
  • Comparison of outcomes for the second twin in combined vaginal/cesarean delivery versus double cesarean delivery.

Main Results:

  • 17% of 1028 twin deliveries were combined vaginal/cesarean.
  • Longer membrane-rupture-to-delivery interval in the combined group (3.2 vs. 2.3 hours).
  • Higher incidence of endometritis (OR 1.6) and neonatal sepsis (OR 1.8) in the second twin of the combined group, though not significant after logistic regression.

Conclusions:

  • Combined twin delivery may be linked to increased endometritis and neonatal sepsis.
  • No significant differences observed in severe neonatal outcomes such as hypoxic ischemic encephalopathy or death.
  • Route of delivery for the second twin did not impact the most severe neonatal sequelae.