Safety of vaginal delivery among dichorionic diamniotic twins over 10 years in a UK teaching hospital

Int J Gynaecol Obstet. 2017 Jan;136(1):98-101. doi: 10.1002/ijgo.12017. Epub 2016 Nov 3.

Abstract

Objective: To determine whether vaginal delivery among dichorionic diamniotic twins remains a safe option following full implementation of the European Working Time Directive in the UK.

Methods: A retrospective study was conducted using data for women with dichorionic diamniotic twin pregnancies who attended a teaching hospital in London, UK, for delivery between January 4, 2000, and December 23, 2010.

Results: Among 892 women, 474 (53.1%) attempted vaginal delivery, 220 (46.4%) of whom achieved spontaneous vaginal delivery of both twins. Instrumental vaginal delivery was performed among 89 women (18.8%), and 165 (34.8%) women underwent emergency cesarean delivery. Delivery of the second twin by emergency cesarean (n=31) was predominantly for fetal distress (13 [41.9%]) or abnormal lie (10 [32.3%]). A 5-minute Apgar score of 9 or 10 was recorded for 384 (83.7%) of 459 first twins and 369 (82.9%) of 445 second twins, irrespective of the mode of delivery.

Conclusion: Vaginal delivery among dichorionic diamniotic twins had a good success rate and a low intrapartum emergency cesarean delivery rate. Training in cardiotocography and intrapartum procedures might further reduce the need for emergency cesarean delivery.

Keywords: Cardiotocography; Cesarean delivery; Dichorionic diamniotic twins; Internal podalic version; Training; Vaginal delivery.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Apgar Score
  • Cardiotocography / methods
  • Cesarean Section / adverse effects
  • Cesarean Section / statistics & numerical data*
  • Female
  • Hospitals, Teaching
  • Humans
  • Infant, Newborn
  • Labor, Obstetric / physiology*
  • London
  • Parturition
  • Pregnancy
  • Pregnancy, Twin / statistics & numerical data*
  • Retrospective Studies
  • Time Factors