A C Rossi1, P M Mullin, R H Chmait. 1. Clinic of Obstetrics and Gynaecology, San Giacomo Hospital, Monopoli, Via Celentano 42, Bari, Italy. acristinarossi@yahoo.it
Abstract
BACKGROUND: The optimal mode of delivery for twins is undetermined. OBJECTIVE: To review literature regarding the neonatal outcomes following twin delivery. DATA SOURCES: Searches were conducted in PubMed, Medline, Embase, Cochrane library and reference lists. SELECTION CRITERIA: Studies selection criteria were: both twins alive at labour, outcomes stratified for birth order, presentation, planned and actual delivery mode. Eighteen articles were included in the meta-analysis (39, 571 twin sets). DATA COLLECTION AND ANALYSIS: The Meta-analysis of Observational Studies in Epidemiology guidelines were followed. Interstudy heterogeneity (I(2) ) was tested. A fixed model was generated whenever I(2)<25%. Pooled odds ratios (OR) with 95% CI were computed. Intergroup comparison was significant if 95% CI did not encompass 1. The first and second twins were indicated as Twin A (TA) and Twin B (TB), respectively. MAIN RESULTS: Neonatal morbidity was lower in TA than TB (3.0 versus 4.6%; OR 0.53; 95% CI 0.39-0.70). TA experienced neonatal death less often than TB (0.3 versus 0.6%; OR 0.55; 95% CI 0.38-0.81). No differences were noted between vertex and non-vertex and attempted vaginal delivery versus planned caesarean section in either TA or TB. In TA, neonatal morbidity was lower after vaginal delivery (1.1%) than caesarean section (2.2%; OR 0.47; 95% CI 0.27-0.82). Neonatal death was not associated with actual delivery mode. In TB, morbidity following combined delivery (19.8%) was higher than after vaginal delivery (9.5%; OR 0.55; 95% CI 0.41-0.74) or caesarean section (9.8%; OR 0.47; 95% CI 0.43-0.53). When outcomes were stratified for both presentation and delivery mode, mortality rate was lower after vaginal delivery than caesarean section for both vertex and nonvertex TB. AUTHOR'S CONCLUSION: An attempt at vaginal delivery should be considered in twin pregnancies with vertex/vertex presentation.
BACKGROUND: The optimal mode of delivery for twins is undetermined. OBJECTIVE: To review literature regarding the neonatal outcomes following twin delivery. DATA SOURCES: Searches were conducted in PubMed, Medline, Embase, Cochrane library and reference lists. SELECTION CRITERIA: Studies selection criteria were: both twins alive at labour, outcomes stratified for birth order, presentation, planned and actual delivery mode. Eighteen articles were included in the meta-analysis (39, 571 twin sets). DATA COLLECTION AND ANALYSIS: The Meta-analysis of Observational Studies in Epidemiology guidelines were followed. Interstudy heterogeneity (I(2) ) was tested. A fixed model was generated whenever I(2)<25%. Pooled odds ratios (OR) with 95% CI were computed. Intergroup comparison was significant if 95% CI did not encompass 1. The first and second twins were indicated as Twin A (TA) and Twin B (TB), respectively. MAIN RESULTS: Neonatal morbidity was lower in TA than TB (3.0 versus 4.6%; OR 0.53; 95% CI 0.39-0.70). TA experienced neonatal death less often than TB (0.3 versus 0.6%; OR 0.55; 95% CI 0.38-0.81). No differences were noted between vertex and non-vertex and attempted vaginal delivery versus planned caesarean section in either TA or TB. In TA, neonatal morbidity was lower after vaginal delivery (1.1%) than caesarean section (2.2%; OR 0.47; 95% CI 0.27-0.82). Neonatal death was not associated with actual delivery mode. In TB, morbidity following combined delivery (19.8%) was higher than after vaginal delivery (9.5%; OR 0.55; 95% CI 0.41-0.74) or caesarean section (9.8%; OR 0.47; 95% CI 0.43-0.53). When outcomes were stratified for both presentation and delivery mode, mortality rate was lower after vaginal delivery than caesarean section for both vertex and nonvertex TB. AUTHOR'S CONCLUSION: An attempt at vaginal delivery should be considered in twin pregnancies with vertex/vertex presentation.
Authors: Anders J Svendsen; Kirsten O Kyvik; Gunnar Houen; Christian Nielsen; René Holst; Axel Skytthe; Peter Junker Journal: Rheumatol Int Date: 2013-11-05 Impact factor: 2.631
Authors: Elise M A Slob; Bronwyn K Brew; Susanne J H Vijverberg; Talitha Dijs; Catharina E M van Beijsterveldt; Gerard H Koppelman; Meike Bartels; Conor V Dolan; Henrik Larsson; Sebastian Lundström; Paul Lichtenstein; Tong Gong; Anke H Maitland-van der Zee; Aletta D Kraneveld; Catarina Almqvist; Dorret I Boomsma Journal: Int J Epidemiol Date: 2021-05-17 Impact factor: 7.196