Document Detail


Active second-stage management in twin pregnancies undergoing planned vaginal delivery in a U.S. population.
MedLine Citation:
PMID:  20093893     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To estimate neonatal morbidity and delivery outcomes according to planned mode of delivery in twin pregnancies with active second-stage management. METHODS: This was an historic cohort of twin pregnancies delivered in one practice between June 2005 and September 2009 using a strict protocol of second-stage management, including breech extraction of a second noncephalic twin and internal version of a nonengaged cephalic second twin followed by breech extraction. Primary outcome was a 5-minute Apgar score less than 7 for twin B. Secondary outcomes were 5-minute Apgar score less than 7 for twin A and 1-minute Apgar score less than 7 and arterial cord pH below 7.20 for each twin. RESULTS: A total of 287 twin pregnancies were included. There were 157 patients (54.7%) in the planned cesarean group and 130 patients (45.3%) in the planned vaginal delivery group. There was no significant difference in the rates of twin B having a 5-minute Apgar score lower than 7 or an arterial cord pH below 7.20. Among the patients in the planned vaginal delivery group, the cesarean delivery rate was 15.4%. No patients had a vaginal delivery of twin A followed by cesarean delivery of twin B. Among the patients in the planned vaginal delivery group, patients who had a successful vaginal delivery were more likely to be younger (31.56+/-6.6 compared with 36.88+/-6.1 years, P=.001) and were more likely to have a prior vaginal delivery (47.3% compared with 15.0%, P=.007). CONCLUSION: Planned vaginal delivery of twin pregnancies seems to be associated with neonatal outcomes similar to those with planned cesarean delivery. Active second-stage management is associated with good neonatal outcomes and a low risk of combined vaginal-cesarean delivery. LEVEL OF EVIDENCE: II.
Authors:
Nathan S Fox; Michael Silverstein; Samuel Bender; Chad K Klauser; Daniel H Saltzman; Andrei Rebarber
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  115     ISSN:  1873-233X     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-01-22     Completed Date:  2010-02-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  229-33     Citation Subset:  AIM; IM    
Affiliation:
Maternal Fetal Medicine Associates, PLLC, New York, New York 10128, USA. nfox@mfmnyc.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Apgar Score
Cesarean Section
Delivery, Obstetric / methods*
Female
Humans
Infant, Newborn
Labor Presentation
Labor Stage, Second
Pregnancy
Twins*
Version, Fetal
Comments/Corrections
Comment In:
Obstet Gynecol. 2010 Feb;115(2 Pt 1):221-2   [PMID:  20093891 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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