| Active second-stage management in twin pregnancies undergoing planned vaginal delivery in a U.S. population. | |
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MedLine Citation:
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PMID: 20093893 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Nathan S Fox; Michael Silverstein; Samuel Bender; Chad K Klauser; Daniel H Saltzman; Andrei Rebarber |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Obstetrics and gynecology Volume: 115 ISSN: 1873-233X ISO Abbreviation: Obstet Gynecol Publication Date: 2010 Feb |
Date Detail:
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Created Date: 2010-01-22 Completed Date: 2010-02-16 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0401101 Medline TA: Obstet Gynecol Country: United States |
Other Details:
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Languages: eng Pagination: 229-33 Citation Subset: AIM; IM |
Affiliation:
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Maternal Fetal Medicine Associates, PLLC, New York, New York 10128, USA. nfox@mfmnyc.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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:
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Obstet Gynecol. 2010 Feb;115(2 Pt 1):221-2
[PMID:
20093891
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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