Management of nonvertex second twin
Farhatulain Ahmed1, Noorikiran Naeem2, Shamila Yasir2
1Gynae Unit II, Fatima memorial hospital, Lahore, Pakistan ; House 32-B, street-1, cavalry ground, Shadman, Lahore, Pakistan.
Journal of Obstetrics and Gynaecology of India
|January 17, 2014
Summary
Attempting labor and active second-stage management in twin pregnancies yields neonatal outcomes comparable to planned cesarean delivery. This approach demonstrates a low risk of combined vaginal-cesarean delivery, offering a safe alternative for twin births.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Neonatal Outcomes
Background:
- Twin pregnancies present unique delivery challenges.
- Management strategies for twin births vary, impacting maternal and neonatal outcomes.
- Comparing planned cesarean delivery with attempted labor is crucial for optimizing care.
Purpose of the Study:
- To compare neonatal outcomes in twin pregnancies managed with attempted labor and active second-stage management versus planned cesarean delivery.
- To evaluate the success rates of external cephalic version (ECV) and internal podalic version (IPV) in the planned vaginal delivery group.
- To assess the rate of emergency cesarean delivery in the planned vaginal delivery group.
Main Methods:
- Retrospective review of 283 twin pregnancies meeting inclusion criteria.
- Categorization into planned cesarean delivery and planned vaginal delivery groups.
- Assessment of fetal outcomes including APGAR scores and NICU admissions.
Main Results:
- 167 patients (59.01%) opted for planned vaginal delivery, with 148 (88.6%) achieving vaginal delivery of both twins.
- External cephalic version (ECV) success rate was 25.3%, and internal podalic version (IPV) success rate was 95.3%.
- No significant difference in Twin B's 5-minute APGAR score or arterial cord pH between groups; planned vaginal delivery group had an 8.3% cesarean delivery rate.
Conclusions:
- Active second-stage management in twin pregnancies is associated with neonatal outcomes similar to planned cesarean delivery.
- This management strategy presents a low risk of combined vaginal-cesarean delivery.
- Attempted labor with active second-stage management is a viable option for twin deliveries, ensuring comparable neonatal safety to cesarean births.
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