Cesarean delivery for the second Twin

James M. Alexander, Kenneth J. Leveno, Dwight Rouse, Mark B. Landon, Sharon A. Gilbert, Catherine Y. Spong, Michael W. Varner, Steve N. Caritis, Margaret Harper, Ronald J. Wapner, Yoram Sorokin, Menachem Miodovnik, Mary J. O'Sullivan, Baha M. Sibai, Oded Langer, Steven G. Gabbe

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

OBJECTIVE: To examine maternal and infant outcomes after a vaginal delivery of twin A and a cesarean delivery of twin B, and to identify whether the second twin experienced increased short-term morbidity as part of a combined route of delivery. METHODS: Between January 1, 1999, and December 31, 2000, a prospective cohort study of all cesarean deliveries was conducted at 13 university centers. This secondary analysis was limited to women with twin gestations who experienced labor and underwent cesarean delivery. We compared outcomes of the second twin in women who had vaginal delivery of the first twin and a cesarean delivery of the second twin to those who had cesarean delivery of both twins. RESULTS: One thousand twenty-eight twin pregnancies experienced labor and underwent cesarean delivery; 179 (17%) had a combined vaginal/cesarean delivery. Gestational age at delivery was 34.6 weeks in both groups (P=.97). The rupture of membranes to delivery interval was longer in the combined group (3.2 compared with 2.3 hours, P<.001). Endometritis and culture-proven sepsis in the second twin were more common in the combined group, respectively (n=24, odds ratio 1.6, 95% confidence interval, 1.0-2.7; n=15, odds ratio 1.8, 95% confidence interval, 1.0-3.4). These differences were not significant after logistic regression analysis. There were no statistically significant differences in an arterial cord pH of less than 7.0, Apgar score less than or equal to 3 at 5 minutes, seizures, grade III or IV intraventricular hemorrhage, hypoxic ischemic encephalopathy, or neonatal death. CONCLUSION: Combined twin delivery may be associated with endometritis and neonatal sepsis when compared with a twin delivery where both are delivered by cesarean in twin pregnancies experiencing labor. More serious neonatal sequelae, including hypoxic ischemic encephalopathy and death, were not affected by the route of delivery of the second twin.

Original languageEnglish (US)
Pages (from-to)748-752
Number of pages5
JournalObstetrics and Gynecology
Volume112
Issue number4
DOIs
StatePublished - Oct 2008

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Brain Hypoxia-Ischemia
Endometritis
Twin Pregnancy
Odds Ratio
Confidence Intervals
Apgar Score
Gestational Age
Rupture
Sepsis
Seizures
Cohort Studies
Logistic Models
Regression Analysis
Mothers
Prospective Studies
Hemorrhage
Morbidity
Pregnancy
Membranes
Perinatal Death

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Alexander, J. M., Leveno, K. J., Rouse, D., Landon, M. B., Gilbert, S. A., Spong, C. Y., ... Gabbe, S. G. (2008). Cesarean delivery for the second Twin. Obstetrics and Gynecology, 112(4), 748-752. https://doi.org/10.1097/AOG.0b013e318187ccb2

Cesarean delivery for the second Twin. / Alexander, James M.; Leveno, Kenneth J.; Rouse, Dwight; Landon, Mark B.; Gilbert, Sharon A.; Spong, Catherine Y.; Varner, Michael W.; Caritis, Steve N.; Harper, Margaret; Wapner, Ronald J.; Sorokin, Yoram; Miodovnik, Menachem; O'Sullivan, Mary J.; Sibai, Baha M.; Langer, Oded; Gabbe, Steven G.

In: Obstetrics and Gynecology, Vol. 112, No. 4, 10.2008, p. 748-752.

Research output: Contribution to journalArticle

Alexander, JM, Leveno, KJ, Rouse, D, Landon, MB, Gilbert, SA, Spong, CY, Varner, MW, Caritis, SN, Harper, M, Wapner, RJ, Sorokin, Y, Miodovnik, M, O'Sullivan, MJ, Sibai, BM, Langer, O & Gabbe, SG 2008, 'Cesarean delivery for the second Twin', Obstetrics and Gynecology, vol. 112, no. 4, pp. 748-752. https://doi.org/10.1097/AOG.0b013e318187ccb2
Alexander JM, Leveno KJ, Rouse D, Landon MB, Gilbert SA, Spong CY et al. Cesarean delivery for the second Twin. Obstetrics and Gynecology. 2008 Oct;112(4):748-752. https://doi.org/10.1097/AOG.0b013e318187ccb2
Alexander, James M. ; Leveno, Kenneth J. ; Rouse, Dwight ; Landon, Mark B. ; Gilbert, Sharon A. ; Spong, Catherine Y. ; Varner, Michael W. ; Caritis, Steve N. ; Harper, Margaret ; Wapner, Ronald J. ; Sorokin, Yoram ; Miodovnik, Menachem ; O'Sullivan, Mary J. ; Sibai, Baha M. ; Langer, Oded ; Gabbe, Steven G. / Cesarean delivery for the second Twin. In: Obstetrics and Gynecology. 2008 ; Vol. 112, No. 4. pp. 748-752.
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abstract = "OBJECTIVE: To examine maternal and infant outcomes after a vaginal delivery of twin A and a cesarean delivery of twin B, and to identify whether the second twin experienced increased short-term morbidity as part of a combined route of delivery. METHODS: Between January 1, 1999, and December 31, 2000, a prospective cohort study of all cesarean deliveries was conducted at 13 university centers. This secondary analysis was limited to women with twin gestations who experienced labor and underwent cesarean delivery. We compared outcomes of the second twin in women who had vaginal delivery of the first twin and a cesarean delivery of the second twin to those who had cesarean delivery of both twins. RESULTS: One thousand twenty-eight twin pregnancies experienced labor and underwent cesarean delivery; 179 (17{\%}) had a combined vaginal/cesarean delivery. Gestational age at delivery was 34.6 weeks in both groups (P=.97). The rupture of membranes to delivery interval was longer in the combined group (3.2 compared with 2.3 hours, P<.001). Endometritis and culture-proven sepsis in the second twin were more common in the combined group, respectively (n=24, odds ratio 1.6, 95{\%} confidence interval, 1.0-2.7; n=15, odds ratio 1.8, 95{\%} confidence interval, 1.0-3.4). These differences were not significant after logistic regression analysis. There were no statistically significant differences in an arterial cord pH of less than 7.0, Apgar score less than or equal to 3 at 5 minutes, seizures, grade III or IV intraventricular hemorrhage, hypoxic ischemic encephalopathy, or neonatal death. CONCLUSION: Combined twin delivery may be associated with endometritis and neonatal sepsis when compared with a twin delivery where both are delivered by cesarean in twin pregnancies experiencing labor. More serious neonatal sequelae, including hypoxic ischemic encephalopathy and death, were not affected by the route of delivery of the second twin.",
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T1 - Cesarean delivery for the second Twin

AU - Alexander, James M.

AU - Leveno, Kenneth J.

AU - Rouse, Dwight

AU - Landon, Mark B.

AU - Gilbert, Sharon A.

AU - Spong, Catherine Y.

AU - Varner, Michael W.

AU - Caritis, Steve N.

AU - Harper, Margaret

AU - Wapner, Ronald J.

AU - Sorokin, Yoram

AU - Miodovnik, Menachem

AU - O'Sullivan, Mary J.

AU - Sibai, Baha M.

AU - Langer, Oded

AU - Gabbe, Steven G.

PY - 2008/10

Y1 - 2008/10

N2 - OBJECTIVE: To examine maternal and infant outcomes after a vaginal delivery of twin A and a cesarean delivery of twin B, and to identify whether the second twin experienced increased short-term morbidity as part of a combined route of delivery. METHODS: Between January 1, 1999, and December 31, 2000, a prospective cohort study of all cesarean deliveries was conducted at 13 university centers. This secondary analysis was limited to women with twin gestations who experienced labor and underwent cesarean delivery. We compared outcomes of the second twin in women who had vaginal delivery of the first twin and a cesarean delivery of the second twin to those who had cesarean delivery of both twins. RESULTS: One thousand twenty-eight twin pregnancies experienced labor and underwent cesarean delivery; 179 (17%) had a combined vaginal/cesarean delivery. Gestational age at delivery was 34.6 weeks in both groups (P=.97). The rupture of membranes to delivery interval was longer in the combined group (3.2 compared with 2.3 hours, P<.001). Endometritis and culture-proven sepsis in the second twin were more common in the combined group, respectively (n=24, odds ratio 1.6, 95% confidence interval, 1.0-2.7; n=15, odds ratio 1.8, 95% confidence interval, 1.0-3.4). These differences were not significant after logistic regression analysis. There were no statistically significant differences in an arterial cord pH of less than 7.0, Apgar score less than or equal to 3 at 5 minutes, seizures, grade III or IV intraventricular hemorrhage, hypoxic ischemic encephalopathy, or neonatal death. CONCLUSION: Combined twin delivery may be associated with endometritis and neonatal sepsis when compared with a twin delivery where both are delivered by cesarean in twin pregnancies experiencing labor. More serious neonatal sequelae, including hypoxic ischemic encephalopathy and death, were not affected by the route of delivery of the second twin.

AB - OBJECTIVE: To examine maternal and infant outcomes after a vaginal delivery of twin A and a cesarean delivery of twin B, and to identify whether the second twin experienced increased short-term morbidity as part of a combined route of delivery. METHODS: Between January 1, 1999, and December 31, 2000, a prospective cohort study of all cesarean deliveries was conducted at 13 university centers. This secondary analysis was limited to women with twin gestations who experienced labor and underwent cesarean delivery. We compared outcomes of the second twin in women who had vaginal delivery of the first twin and a cesarean delivery of the second twin to those who had cesarean delivery of both twins. RESULTS: One thousand twenty-eight twin pregnancies experienced labor and underwent cesarean delivery; 179 (17%) had a combined vaginal/cesarean delivery. Gestational age at delivery was 34.6 weeks in both groups (P=.97). The rupture of membranes to delivery interval was longer in the combined group (3.2 compared with 2.3 hours, P<.001). Endometritis and culture-proven sepsis in the second twin were more common in the combined group, respectively (n=24, odds ratio 1.6, 95% confidence interval, 1.0-2.7; n=15, odds ratio 1.8, 95% confidence interval, 1.0-3.4). These differences were not significant after logistic regression analysis. There were no statistically significant differences in an arterial cord pH of less than 7.0, Apgar score less than or equal to 3 at 5 minutes, seizures, grade III or IV intraventricular hemorrhage, hypoxic ischemic encephalopathy, or neonatal death. CONCLUSION: Combined twin delivery may be associated with endometritis and neonatal sepsis when compared with a twin delivery where both are delivered by cesarean in twin pregnancies experiencing labor. More serious neonatal sequelae, including hypoxic ischemic encephalopathy and death, were not affected by the route of delivery of the second twin.

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