Cesarean section for the second twin: a population-based study of occurrence and outcome

Line Engelbrechtsen; Elise Hoffmann Nielsen; Trine Perin; Anna Oldenburg; Ann Tabor; Lillian Skibsted; Danish Fetal Medicine Study Group; Birgit Bødker; Vibeke Ersbak; Anni Holmskov; Olav Bjørn Petersen; Lene Sperling; Inger Stornes; Helle Zingenberg

doi:10.1111/birt.12023

Cesarean section for the second twin: a population-based study of occurrence and outcome

Line Engelbrechtsen, Elise Hoffmann Nielsen, Trine Perin, Anna Oldenburg, Ann Tabor, Lillian Skibsted, Danish Fetal Medicine Study Group, Birgit Bødker, Vibeke Ersbak, Anni Holmskov, Olav Bjørn Petersen, Lene Sperling, Inger Stornes, Helle Zingenberg

Department of Clinical Medicine

7 Citations (Scopus)

Abstract

BACKGROUND: Although management of twin deliveries has been a topic of discussion for decades, a consensus on how to deliver twins is lacking. The objective of this study was to examine short-term neonatal outcome of the second twin delivered by cesarean section after vaginal delivery of the first-born twin (combined delivery) and to identify predictors of combined delivery.

METHODS: This study was a 3-year, population-based, retrospective cohort investigation of 1,254 twin births in Denmark. The twin births were divided into three groups: vaginal deliveries, planned cesarean deliveries, and combined deliveries. Data were extracted from medical records, a fetal medicine software program (Astraia), and the National Birth Registry. Short-term poor neonatal outcome was measured as a 5-minute Apgar score ≤ 7, umbilical cord pH ≤ 7.10, and admission to neonatal intensive care unit for more than 3 days.

RESULTS: Vertex-nonvertex fetal presentations were more prevalent in combined deliveries than vaginal deliveries (OR 4.4, 2.5-7.8). Nonvertex second twins born by combined delivery had a higher risk of Apgar score ≤ 7 and umbilical cord pH ≤ 7.10 compared with vaginal delivery, unadjusted OR 6.2 (2.1-18), and unadjusted OR 3.9 (1.6-9.5). Prenatal ultrasound scans were evaluated in combined deliveries, of which 48 percent were vertex-vertex at the last ultrasound scan in pregnancy (mean gestational age 34 + 0) and 37 percent were vertex-vertex at birth.

CONCLUSIONS: Vertex-nonvertex presenting twins have an increased risk of combined delivery. Combined deliveries are associated with increased neonatal morbidity for the second twin.

Original language	English
Journal	Birth
Volume	40
Issue number	1
Pages (from-to)	10-16
Number of pages	7
ISSN	0730-7659
DOIs	https://doi.org/10.1111/birt.12023
Publication status	Published - Mar 2013

Access to Document

10.1111/birt.12023

Cite this

Engelbrechtsen, L., Nielsen, E. H., Perin, T., Oldenburg, A., Tabor, A., Skibsted, L., Danish Fetal Medicine Study Group, Bødker, B., Ersbak, V., Holmskov, A., Petersen, O. B., Sperling, L., Stornes, I., & Zingenberg, H. (2013). Cesarean section for the second twin: a population-based study of occurrence and outcome. Birth, 40(1), 10-16. https://doi.org/10.1111/birt.12023

Engelbrechtsen, L, Nielsen, EH, Perin, T, Oldenburg, A, Tabor, A, Skibsted, L, Danish Fetal Medicine Study Group, Bødker, B, Ersbak, V, Holmskov, A, Petersen, OB, Sperling, L, Stornes, I & Zingenberg, H 2013, 'Cesarean section for the second twin: a population-based study of occurrence and outcome', Birth, vol. 40, no. 1, pp. 10-16. https://doi.org/10.1111/birt.12023

@article{df2bc283c21c4322b6d4a56cb3bce88b,

title = "Cesarean section for the second twin: a population-based study of occurrence and outcome",

abstract = "BACKGROUND: Although management of twin deliveries has been a topic of discussion for decades, a consensus on how to deliver twins is lacking. The objective of this study was to examine short-term neonatal outcome of the second twin delivered by cesarean section after vaginal delivery of the first-born twin (combined delivery) and to identify predictors of combined delivery.METHODS: This study was a 3-year, population-based, retrospective cohort investigation of 1,254 twin births in Denmark. The twin births were divided into three groups: vaginal deliveries, planned cesarean deliveries, and combined deliveries. Data were extracted from medical records, a fetal medicine software program (Astraia), and the National Birth Registry. Short-term poor neonatal outcome was measured as a 5-minute Apgar score ≤ 7, umbilical cord pH ≤ 7.10, and admission to neonatal intensive care unit for more than 3 days.RESULTS: Vertex-nonvertex fetal presentations were more prevalent in combined deliveries than vaginal deliveries (OR 4.4, 2.5-7.8). Nonvertex second twins born by combined delivery had a higher risk of Apgar score ≤ 7 and umbilical cord pH ≤ 7.10 compared with vaginal delivery, unadjusted OR 6.2 (2.1-18), and unadjusted OR 3.9 (1.6-9.5). Prenatal ultrasound scans were evaluated in combined deliveries, of which 48 percent were vertex-vertex at the last ultrasound scan in pregnancy (mean gestational age 34 + 0) and 37 percent were vertex-vertex at birth.CONCLUSIONS: Vertex-nonvertex presenting twins have an increased risk of combined delivery. Combined deliveries are associated with increased neonatal morbidity for the second twin.",

author = "Line Engelbrechtsen and Nielsen, {Elise Hoffmann} and Trine Perin and Anna Oldenburg and Ann Tabor and Lillian Skibsted and {Danish Fetal Medicine Study Group} and Birgit B{\o}dker and Vibeke Ersbak and Anni Holmskov and Petersen, {Olav Bj{\o}rn} and Lene Sperling and Inger Stornes and Helle Zingenberg",

note = "{\textcopyright} 2013, Copyright the Authors Journal compilation {\textcopyright} 2013, Wiley Periodicals, Inc.",

year = "2013",

month = mar,

doi = "10.1111/birt.12023",

language = "English",

volume = "40",

pages = "10--16",

journal = "Birth",

issn = "0730-7659",

publisher = "Wiley-Blackwell",

number = "1",

}

TY - JOUR

T1 - Cesarean section for the second twin

T2 - a population-based study of occurrence and outcome

AU - Engelbrechtsen, Line

AU - Nielsen, Elise Hoffmann

AU - Perin, Trine

AU - Oldenburg, Anna

AU - Tabor, Ann

AU - Skibsted, Lillian

AU - Danish Fetal Medicine Study Group

AU - Bødker, Birgit

AU - Ersbak, Vibeke

AU - Holmskov, Anni

AU - Petersen, Olav Bjørn

AU - Sperling, Lene

AU - Stornes, Inger

AU - Zingenberg, Helle

PY - 2013/3

Y1 - 2013/3

N2 - BACKGROUND: Although management of twin deliveries has been a topic of discussion for decades, a consensus on how to deliver twins is lacking. The objective of this study was to examine short-term neonatal outcome of the second twin delivered by cesarean section after vaginal delivery of the first-born twin (combined delivery) and to identify predictors of combined delivery.METHODS: This study was a 3-year, population-based, retrospective cohort investigation of 1,254 twin births in Denmark. The twin births were divided into three groups: vaginal deliveries, planned cesarean deliveries, and combined deliveries. Data were extracted from medical records, a fetal medicine software program (Astraia), and the National Birth Registry. Short-term poor neonatal outcome was measured as a 5-minute Apgar score ≤ 7, umbilical cord pH ≤ 7.10, and admission to neonatal intensive care unit for more than 3 days.RESULTS: Vertex-nonvertex fetal presentations were more prevalent in combined deliveries than vaginal deliveries (OR 4.4, 2.5-7.8). Nonvertex second twins born by combined delivery had a higher risk of Apgar score ≤ 7 and umbilical cord pH ≤ 7.10 compared with vaginal delivery, unadjusted OR 6.2 (2.1-18), and unadjusted OR 3.9 (1.6-9.5). Prenatal ultrasound scans were evaluated in combined deliveries, of which 48 percent were vertex-vertex at the last ultrasound scan in pregnancy (mean gestational age 34 + 0) and 37 percent were vertex-vertex at birth.CONCLUSIONS: Vertex-nonvertex presenting twins have an increased risk of combined delivery. Combined deliveries are associated with increased neonatal morbidity for the second twin.

AB - BACKGROUND: Although management of twin deliveries has been a topic of discussion for decades, a consensus on how to deliver twins is lacking. The objective of this study was to examine short-term neonatal outcome of the second twin delivered by cesarean section after vaginal delivery of the first-born twin (combined delivery) and to identify predictors of combined delivery.METHODS: This study was a 3-year, population-based, retrospective cohort investigation of 1,254 twin births in Denmark. The twin births were divided into three groups: vaginal deliveries, planned cesarean deliveries, and combined deliveries. Data were extracted from medical records, a fetal medicine software program (Astraia), and the National Birth Registry. Short-term poor neonatal outcome was measured as a 5-minute Apgar score ≤ 7, umbilical cord pH ≤ 7.10, and admission to neonatal intensive care unit for more than 3 days.RESULTS: Vertex-nonvertex fetal presentations were more prevalent in combined deliveries than vaginal deliveries (OR 4.4, 2.5-7.8). Nonvertex second twins born by combined delivery had a higher risk of Apgar score ≤ 7 and umbilical cord pH ≤ 7.10 compared with vaginal delivery, unadjusted OR 6.2 (2.1-18), and unadjusted OR 3.9 (1.6-9.5). Prenatal ultrasound scans were evaluated in combined deliveries, of which 48 percent were vertex-vertex at the last ultrasound scan in pregnancy (mean gestational age 34 + 0) and 37 percent were vertex-vertex at birth.CONCLUSIONS: Vertex-nonvertex presenting twins have an increased risk of combined delivery. Combined deliveries are associated with increased neonatal morbidity for the second twin.

U2 - 10.1111/birt.12023

DO - 10.1111/birt.12023

M3 - Journal article

C2 - 24635419

SN - 0730-7659

VL - 40

SP - 10

EP - 16

JO - Birth

JF - Birth

IS - 1

ER -

Cesarean section for the second twin: a population-based study of occurrence and outcome

Abstract

Access to Document

Fingerprint

Cite this