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Model Surgical Training: Skills Acquisition in Fetoscopic Laser Photocoagulation of Monochorionic Diamniotic Twin Placenta Using Realistic Simulators
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Twin delivery: method, timing and conduct.

Jon F R Barrett1

  • 1Professor and Chief of Maternal Fetal Medicine, University of Toronto, Sunnybrook Health Science Centre, Aubrey and Marla Dan Program, 2075 Bayview Ave, M4 - 172, Toronto M4N 3M5, Canada.

Best Practice & Research. Clinical Obstetrics & Gynaecology
|January 22, 2014
PubMed
Summary
This summary is machine-generated.

Twin pregnancy rates are rising. For twin A presenting vertex, vaginal delivery is recommended, but planned cesarean delivery for the second twin offers no fetal advantage, according to a large trial.

Keywords:
Twin Birth Studyepidural in twin deliverythe non-vertex second twintime interval in twin deliverytwin caesarean sectiontwin gestationtwin pregnancyvaginal delivery in twins

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Perinatology

Background:

  • Rising incidence of twin pregnancies globally, primarily due to assisted reproductive technologies.
  • Unique challenges in labor and delivery for twins, particularly intrapartum monitoring and operative interventions for the second twin.
  • Previous data suggested potential benefits of lower segment cesarean section for the second twin's outcome.

Purpose of the Study:

  • To evaluate the fetal and maternal outcomes of planned vaginal versus planned cesarean delivery in twin gestations.
  • To provide evidence-based recommendations for the mode of delivery in twin pregnancies.

Main Methods:

  • A large, multicenter, randomized-controlled trial comparing planned vaginal delivery with planned cesarean delivery for twins.
  • Inclusion criteria focused on specific fetal presentations and gestational ages.
  • Detailed intrapartum monitoring and standardized delivery protocols were employed.

Main Results:

  • The Twin Birth Study found no significant advantage for planned cesarean delivery over planned vaginal delivery for the second twin.
  • Adherence to established guidelines for vaginal twin delivery is crucial for favorable outcomes.
  • Vaginal delivery is a safe option when twin A presents vertex, provided specific protocols are followed.

Conclusions:

  • Planned cesarean delivery is not advantageous for the fetus in twin gestations.
  • Vaginal delivery for twin A presenting vertex is recommended, emphasizing adherence to delivery guidelines.
  • These findings impact current clinical practice and recommendations for twin birth management.