Evaluation of vaginal birth safety in twin pregnancies with the first
twin in cephalic presentation
Abstract
Objective: To evaluate vaginal birth safety by comparing the results of
cesarean birth in twin pregnancies with the first twin in vertex
presentation. Materials and methods: A retrospective cohort study of
vertex-presenting twin pregnancies between 32 weeks 0 days and 38 weeks
6 days of gestation was conducted at our hospital from January 2013 to
December 2015. The study population was divided according to the mode of
birth. The primary outcome was early neonatal mortality, and secondary
outcomes related to maternal and perinatal clinical characteristics were
analysed between the groups. Results: Of 45,166 births, 1.92% (n = 869)
were twin pregnancies. Of the 295 pregnancies meeting the study
criteria, 30.16% (n = 89) were in the vaginal birth group, while the
remaining 69.84% (n = 206) were in the cesarean birth group. In the
vaginal birth group, all the first twins were delivered via vaginal
birth, while among the second twins, 82.03% (n = 73) were delivered via
vaginal birth, and the remaining 17.97% (n = 16) were delivered via
cesarean birth. In the vaginal birth group, the early neonatal mortality
rate was 2.24% (n = 2), and it was 0.97% (n = 2) in the cesarean birth
group. All of the deaths occurred in pregnancies under 37 weeks of
gestation. Conclusion: The neonatal outcomes between the vaginal birth
and cesarean birth groups were similar in term pregnancies with the
first in twin vertex presentation, whereas adverse neonatal outcomes
were increased in the vaginal birth group in preterm second twin
pregnancies.