Influence of chorionicity in intra-partum management of twin deliveries.

OBJECTIVE: To analyze morbidity and mortality in twin pregnancies as a function of the type of delivery and chorionicity. DESIGN: Retrospective cohort study. METHODS: Analysis of the type of delivery, intertwin time interval, and perinatal variables of >1000 twin deliveries during a 10-year period. MAIN OUTCOME MEASURE: Influence of delivery type and chorionicity on perinatal outcome. RESULTS: The rate of cesarean sections was 42.4%. No differences were found as a function of chorionicity or as a function of presentation of the second twin. Cesarean sections were performed after vaginal delivery of the first twin in 1.8% of cases, being more common if the second baby was in a non-cephalic presentation (6.9% vs. 0.4%, p < 0.05). The average twin-to-twin delivery time interval was longer in the cases where the second had a cephalic presentation (8.26 ± 7.75 min vs. 6.81 ± 5.97 min, p < 0.05). The umbilical artery pH was lower the longer the interval between the birth of the twins, both in monochorionic and dichorionic. CONCLUSIONS: According to the results, vaginal delivery is as safe as elective caesarean section in twin pregnancies where the first twin is in cephalic presentation and the intrapartum management should not vary due to chorionicity.

Atosiban vs. ritodrine as a tocolytic in external cephalic version at term: a prospective cohort study.

OBJECTIVE: To compare the success rate of external cephalic version (ECV) at term using ritodrine or atosiban as a tocolytic agent. STUDY DESIGN: Prospective cohort study with a sample of 236 pregnant women with a breech presentation at term, from November 2006 to March 2008. Data have been analyzed from the moment the cephalic version is performed until the time of delivery. RESULTS: ECV success rate using ritodrine as a tocolytic agent was 56.8% compared to 31.4% with atosiban. Ritodrine increases the version success potential more significantly than atosiban (P<0.05). In both cases, the use of ECV reduced the rate of cesarean sections, although a higher number of versions are required with atosiban [numbers needed to treat (NNT)=9.08] to avoid a cesarean section compared to ritodrine (NNT=3.41). CONCLUSIONS: Ritodrine seems better than atosiban as tocolytic agent for ECVs.

Análisis del dolor en la versión cefálica externa / Analysis of pain in external cephalic version

Objetivo: Analizar el dolor materno durante la versión cefálica externa. Material y métodos: Estudio prospectivo en 71 pacientes, en el Hospital de Cruces, entre abril de 2005 y abril de 2006, mediante una encuesta personal tras la versión. Esta incluía una «escala numérica» de evaluación del dolor, así como preguntas relacionadas con el procedimiento. Se han analizado los resultados en función del éxito o fracaso del procedimiento. Resultados: La tasa de éxito global fue del 50,7%. Todas las gestantes lo toleraron bien y no hubo ninguna complicación. La mediana global de dolor fue 7; fue 5 en las versiones con éxito frente a 8 en las que fracasó (p < 0,01). El 83,1% repetiría el procedimiento; siendo más del 50% por el beneficio del parto en cefálica. Conclusiones: La versión cefálica externa es un procedimiento bien tolerado, probablemente debido a su brevedad, si bien es un procedimiento no exento de dolor (AU)

Objective: To analyze the maternal perception of pain during external cephalic version. Material and methods: A prospective study was carried out on 71 patients at the Hospital de Cruces between April 2005 and April 2006, based on personal surveys conducted after the version. These surveys included a «numeric pain intensity rating scale» as well as a series of questions regarding the procedure. Results were analyzed in terms of success or failure of the procedure. Results: The overall success rate was 50.7%. The procedure was well tolerated by all pregnant women, with no complications being observed. The overall median pain stood at 7; 5 in successful versions, as opposed to 8 in unsuccessful versions (P<.01). A total of 83.1% of patients stated that they would be willing to undergo the procedure again in the future, more than 50% of them basing their decision on the benefits of cephalic delivery. Conclusions: The fact that external cephalic version is a well tolerated procedure is probably due to its brevity, although it must be noted that it is not a pain-free maneuver (AU)