Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-76fb5796d-x4r87 Total loading time: 0 Render date: 2024-04-25T14:02:34.430Z Has data issue: false hasContentIssue false

Chapter 24 - Mode of Delivery in Multiple Pregnancy

Published online by Cambridge University Press:  11 October 2022

By
Amir Aviram ,
Jon F. R. Barret ,
Elad Mei-Dan  and
Nir Melamed
Edited by
Leanne Bricker ,
Julian N. Robinson  and
Baskaran Thilaganathan
Leanne Bricker
Affiliation:
Corniche Hospital, Abu Dhabi
Julian N. Robinson
Affiliation:
Brigham & Women's Hospital, Boston
Baskaran Thilaganathan
Affiliation:
St George's Hospital Medical School, University of London
Get access

Summary

The Mode of delivery in twin gestation has long been a matter of debate. The Twin Birth Study (TBS) supplied care givers with an answer to some of the questions. In patients with twin gestation between 32 and 38 weeks of gestation, with the first twin in cephalic presentation, that match the inclusion criteria of the TBS, the neonatal and maternal outcomes of a planned trial of a vaginal delivery are not different than those associated with a planned cesarean section. Yet, gestational age at birth, estimated fetal weight and weight difference between the twins, presentations, chorionicity, care giver’s experience – are some of the many factors that influence the decision regarding mode of delivery, and the outcome of birth in multiple pregnancy. This chapter will describe the evidence or in its absence expert view with regard to mode of delivery in uncomplicated twin pregnancy but also special circumstances such as delivery of the non-vertex second twin, combined delivery, time interval between delivery of twins, breech presenting twin, monoamniotic twins, monochorionic diamniotic twins, vaginal birth after caesarean in twins, preterm and low birthweight twins and higher order multiples.

Keywords

twinsmode of deliverytiming of deliverymanagementneonatal outcomes
Type
Chapter
Information
Management of Multiple Pregnancies
A Practical Guide
 , pp. 249 - 258
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Barrett, JFR, Hannah, ME, Hutton, EK et al. A randomized trial of planned cesarean or vaginal delivery for twin pregnancy. N Engl J Med 2013;369(14):1295–1305. https://doi.org/10.1056/NEJMoa1214939Google Scholar
Rabinovici, J, Barkai, G, Reichman, B, Serr, DM, Mashiach, S. Randomized management of the second nonvertex twin: vaginal delivery or cesarean section. Am J Obstet Gynecol 1987;156(1):52–6. www.ncbi.nlm.nih.gov/pubmed/3799768Google Scholar
Rossi, AC, Mullin, PM, Chmait, RH. Neonatal outcomes of twins according to birth order, presentation and mode of delivery: a systematic review and meta-analysis. BJOG 2011;118(5):523–32. https://doi.org/10.1111/j.1471-0528.2010.02836.xCrossRefGoogle ScholarPubMed
Zafarmand, MH, Goossens, SMTA, Tajik, P et al. Planned cesarean or planned vaginal delivery for twins: a secondary analysis of a randomized controlled trial. Ultrasound Obstet Gynecol October 2019. https://doi.org/10.1002/uog.21907Google Scholar
Mei-Dan, E, Dougan, C, Melamed, N et al. Planned cesarean or vaginal delivery for women in spontaneous labor with a twin pregnancy: a secondary analysis of the Twin Birth Study. Birth 2019;46(1):193–200. https://doi.org/10.1111/birt.12387Google Scholar
Mei-Dan, E, Asztalos, EV, Willan, AR, Barrett, JFR. The effect of induction method in twin pregnancies: a secondary analysis for the twin birth study. BMC Pregnancy Childbirth 2017;17(1). https://doi.org/10.1186/s12884-016-1201-8Google Scholar
Asztalos, E V, Hannah, ME, Hutton, EK et al. Twin Birth Study: 2-year neurodevelopmental follow-up of the randomized trial of planned cesarean or planned vaginal delivery for twin pregnancy presented at the annual pregnancy meeting of the Society for Maternal-Fetal Medicine, Atlanta, GA, Feb. 4, 2016.Am J Obstet Gynecol 2016;214(3):371.e1–371.e19. https://doi.org/10.1016/j.ajog.2015.12.051Google Scholar
Hutton, EK, Hannah, ME, Willan, AR et al. Urinary stress incontinence and other maternal outcomes 2 years after caesarean or vaginal birth for twin pregnancy: a multicentre randomised trial. BJOG 2018;125(13):1682–90. https://doi.org/10.1111/1471-0528.15407Google Scholar
Schmitz, T, Prunet, C, Azria, E et al. Association between planned cesarean delivery and neonatal mortality and morbidity in twin pregnancies. Obstet Gynecol 2017;129(6):986–95. https://doi.org/10.1097/AOG.0000000000002048Google Scholar
Hannah, ME, Hannah, WJ, Hewson, SA, Hodnett, ED, Saigal, S, Willan, AR. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group. Lancet 2000;356(9239):1375–83. https://doi.org/10.1016/s0140-6736(00)02840-3Google Scholar
Dotters-Katz, SK, Gray, B, Heine, RP, Propst, K. Resident education in complex obstetric procedures: are we adequately preparing tomorrow’s obstetricians? Am J Perinatol 2020;37(11):1155–9. https://doi.org/10.1055/s-0039-1692714Google Scholar
Chervenak, FA, Johnson, RE, Berkowitz, RL, Hobbins, JC. Intrapartum external version of the second twin. Obstet Gynecol 1983;62(2):160–5. www.ncbi.nlm.nih.gov/pubmed/6866357Google Scholar
Aviram, A, Lipworth, H, Asztalos, EV et al. The worst of both worlds – combined deliveries in twin gestations: a subanalysis of the Twin Birth Study, a randomized, controlled, prospective study. Am J Obstet Gynecol 2019;221(4):353.e1–353.e7. https://doi.org/10.1016/j.ajog.2019.06.047Google Scholar
Schneuber, S, Magnet, E, Haas, J et al. Twin-to-twin delivery time: neonatal outcome of the second twin. Twin Res Hum Genet 2011;14(6):573–9. https://doi.org/10.1375/twin.14.6.573Google Scholar
Cukierman, R, Heland, S, Palmer, K, Neil, P, da Silva Costa, F, Rolnik, DL. Inter-twin delivery interval, short-term perinatal outcomes and risk of caesarean for the second twin. Aust New Zeal J Obstet Gynaecol 2019;59(3):375–9. https://doi.org/10.1111/ajo.12867Google Scholar
National Institute for Health and Care Excellence. NICE guideline 137: twin and triplet pregnancy. 2019;(March):1–69. www.nice.org.uk/guidance/ng137Google Scholar
Bisschop, CNS, Vogelvang, TE, May, AM, Schuitemaker, NWE. Mode of delivery in non-cephalic presenting twins: a systematic review. Arch Gynecol Obstet 2012;286(1):237–47. https://doi.org/10.1007/s00404-012-2294-6Google Scholar
Barrett, J, Blocking, A. Management of twin pregnancies (part I). J SOGC 2000;22(7):519–29. https://doi.org/10.1016/s0849-5831(16)30135-5Google Scholar
Practice Bulletin No. 169: multifetal gestations: twin, triplet, and higher-order multifetal pregnancies. Obstet Gynecol 2016;128(4):e131–e146. https://doi.org/10.1097/AOG.0000000000001709Google Scholar
Aviram, A, Lipworth, H, Asztalos, EV et al. Delivery of monochorionic twins: lessons learned from the Twin Birth Study, a randomized, controlled, prospective study (unpublished data). Toronto, 2019.Google Scholar
Dagenais, C, Lewis-Mikhael, AM, Grabovac, M, Mukerji, A, McDonald, SD. What is the safest mode of delivery for extremely preterm cephalic/non-cephalic twin pairs? A systematic review and meta-analyses. BMC Pregnancy Childbirth 2017;17(1). Article number 397. https://doi.org/10.1186/s12884-017-1554-7Google Scholar
Grabovac, M, Karim, JN, Isayama, T, Liyanage, SK, McDonald, SD. What is the safest mode of birth for extremely preterm breech singleton infants who are actively resuscitated? A systematic review and meta-analyses. BJOG 2018;125(6):652–63. https://doi.org/10.1111/1471-0528.14938Google Scholar
Shinar, S, Agrawal, S, Hasan, H, Berger, H. Trial of labor versus elective repeat cesarean delivery in twin pregnancies after a previous cesarean delivery: a systematic review and meta-analysis. Birth 2019;(April):1–10. https://doi.org/10.1111/birt.12434Google Scholar
Kabiri, D, Masarwy, R, Schachter-Safrai, N et al. Trial of labor after cesarean delivery in twin gestations: systematic review and meta-analysis. Am J Obstet Gynecol 2019;220(4):336–47. https://doi.org/10.1016/j.ajog.2018.11.125Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×