Planned cesarean section versus planned vaginal birth in vertex-nonvertex twin pregnancies: maternal and neonatal outcomes

ABSTRACT

Over 97% of all multiple pregnancies are twin pregnancies and 35% of twins present as cephalic/noncephalic at birth. The approach to the delivery of cephalic/noncephalic twins is controversial. The purpose of this study is to compare between planned cesarean section [CS] and planned vaginal birth [VB] for delivery of vertex-nonvertex twins in terms of perinatal/ neonatal mortality and morbidity and maternal morbidity. The study is a randomized controlled trial [RCT], included 120 women with twin pregnancies and within gestational age groups [32-38 weeks] with twin A in cephalic presentation, they were randomized to either planned CS group [n = 60] or planned VB group [n = 60]. The study was carried out in Assiut University Hospital, Assiut, Egypt, through the period from October 2003 to August 2005. No perinatal death was reported in twins A born in the CS group compared to 2 perinatal deaths [3.3%] in the VB group. However, 4 perinatal deaths [6.7%] were reported in twins B born in CS group compared to 14 perinatal deaths [23.3%] in the VB group. Neonatal resuscitation, birth trauma, respiratory and cerebral complications were higher among twins born in VB group than those in CS group. Maternal morbidity as birth canal trauma, pos-partum hemorrhage, urinary incontinence and fecal/flatal incontinence were higher among women delivered by planned VB than those delivered by planned CS. The conclusion of the present study is that planned CS at 38 weeks gestation for delivery of vertex-nonvertex twins may be better than planned VB. A multicentre RCT with large sample size is needed to test this suggestion