With Appropriate Selection, Trial of Labor for Twin Birth Is Safe

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With Appropriate Selection, Trial of Labor for Twin Birth Is Safe

Three quarters of twin gestations could be delivered vaginally with minimal morbidity.

Twin pregnancy rates continue to rise; however, consensus about the safest delivery mode is lacking. Researchers in Ireland conducted a prospective multicenter study to determine predictors of successful vaginal twin birth and to assess perinatal morbidity in relation to delivery mode (elective cesarean delivery, prelabor emergency cesarean delivery, or trial of labor) in a cohort of 971 women with twin pregnancies. A composite measure of adverse perinatal outcomes was analyzed according to mode of delivery.

Cesarean delivery was planned in 430 women, and emergent prelabor cesarean delivery was performed in 100 women. Trial of labor was attempted by 441 women, 338 of whom (77%) were successful. Vaginal breech extraction was required for the second twin in 97 of the successful deliveries; in 56 of these cases, vertex presentation of the second twin was noted on ultrasound within 2 weeks of delivery. The cesarean delivery rate for the second twin was 4%. Perinatal morbidity did not differ among groups. Multiparity and spontaneous conception predicted successful vaginal delivery.

Comment: This study provides helpful data for counseling pregnant women with twins. An interesting finding is that presentation of the second twin on ultrasound within 2 weeks before onset of labor bore little relation to fetal presentation following delivery of the first twin; thus, such ultrasound findings might be of limited use for intrapartum management decisions. Overall, these results reinforce that, with careful selection and under appropriate conditions, vaginal twin birth can be successful with minimal morbidity.

— Diane J. Angelini, EdD, CNM, FACNM, FAAN, NEA-BC

Published in Journal Watch Women's Health November 3, 2011

Citation(s):

Breathnach FM et al. Prediction of safe and successful vaginal twin birth. Am J Obstet Gynecol 2011 Sep; 205:237.e1. (http://dx.doi.org/10.1016/j.ajog.2011.05.033)

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