Geburtshilfe Frauenheilkd 2006; 66 - PO_G_03_18
DOI: 10.1055/s-2006-952734

Twin pregnancy: Neonatal outcome of second twins depending on presentation and mode of delivery

D Schlembach 1, V Bjelic-Radisic 1, G Pristauz-Telsnigg 1, J Haas 1, A Guliani 1, K Tamussino 1, U Lang 1
  • 1Medizinische Universität Graz, Universitätsfrauenklinik, Graz, Österreich

Objective: To examine the neonatal outcome in twin pregnancies depending on presentation and mode of delivery.

Methods: Using a database we analyzed the short-term neonatal outcome in twin pregnancies with special emphasis on the second twin depending on the presentation and the mode of delivery. Neonatal outcome was evaluated by Apgar scores, umbilical cord blood pH values, and perinatal or neonatal morbidity and mortality.

Results: Overall, out of 300 pregnancies in 223 (74%) pregnancies both twins were delivered vaginally (VB-VB), 63 (21%) women had to be delivered by cesarean section of both twins (CS-CS) and in 14 (5%) women the second twin had to be delivered by cesarean delivery after vaginal birth of the first twin (VB-CS). Successful VB was most common for vertex-vertex (n=171, 82%) and vertex-nonvertex (n=48, 66%) presentation. Twins delivered by VB-CS had the lowest values for pHart (P=.003) and pHven (P=.012). PHart ≤ 7.00 values were seen only in second twins delivered VB-VB or VB-CS. Lower Apgar scores, pHart ≤ 7.15 or ≤ 7.0 of the second twin occurred more frequent in the VB-VB and VB-CS compared with CS-CS groups (P=.001). Apgar scores ≤ 4 at 1 minute and lower levels of pHart (P=.001) and pHven (P=.015) occurred more often in non-vertex second twins than in vertex second twins (P<.001).

Conclusion: The high CS rate in V/NV presentation and the significantly worse neonatal short-term outcome of NV second twins after VB of the first twin underline a protective effect of primary cesarean section for those pregnancies.