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Summary
Twin delivery outcomes show zero neonatal mortality for cesarean-delivered nonvertex twins and vaginally delivered second twins. Breech extraction of the second twin did not significantly increase low Apgar scores, suggesting vaginal delivery is a viable option.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Perinatal Medicine
- Maternal-Fetal Medicine
Background:
- Twin deliveries present unique challenges for perinatal care.
- Assessing the safety of different delivery modes for the second twin is crucial for optimizing neonatal outcomes.
- Previous data on vaginal delivery of nonvertex second twins was limited.
Purpose of the Study:
- To evaluate neonatal mortality rates in twin deliveries based on presentation and mode of delivery.
- To compare the safety of vaginal extraction versus cesarean section for the second twin.
- To determine if breech extraction of the second twin impacts neonatal Apgar scores.
Main Methods:
- Retrospective chart review of twin deliveries from April 1, 1977, to March 20, 1980.
- Hospitals included: Boston City Hospital and Brigham and Women's Hospital.
- Analysis of neonatal mortality and 5-minute Apgar scores based on twin presentation and delivery method.
Main Results:
- Zero corrected neonatal mortality was observed for 74 nonvertex twins delivered via cesarean section.
- Zero corrected neonatal mortality was observed for 76 second-born twins delivered vaginally.
- Breech extraction of 76 second-born twins (birth weight >1499g) showed no significant increase in low 5-minute Apgar scores compared to cesarean-delivered nonvertex twins.
Conclusions:
- Vaginal delivery of the second twin, even in breech presentation, appears safe with low neonatal mortality.
- Consideration for vaginal delivery of the second twin weighing >1500-2000g in breech presentation is supported by these findings.
- Cesarean section for nonvertex twins and vaginal extraction for second twins demonstrated comparable safety in this cohort.