The relationship of infection to method of delivery in twin pregnancy

Maternal postpartum complications according to delivery mode in twin pregnancies

OBJECTIVE

We aimed to examine maternal postpartum complications of twin deliveries according to mode of delivery and investigate the associated risk factors.

METHODS

This was a retrospective cohort review of twin pregnancies with delivery after 26 weeks at a tertiary teaching hospital (1993-2008). The rates of maternal postpartum complications were compared among vaginal, elective cesarean and emergency cesarean deliveries. Significant predictors of complications were investigated with stepwise regression analysis and relative risks were calculated.

RESULTS

A total of 90 complications were observed in 56/817 (6.9%) deliveries: 7/131 (5.3%) vaginal, 10/251 (4.0%) elective cesarean and 39/435 (9.0%) emergency cesarean deliveries. Significant predictors included high-risk pregnancy, gestational age at birth and delivery mode. The occurrence of complications was significantly increased in emergency compared to elective cesarean deliveries (RR=2.34).

CONCLUSIONS

Maternal postpartum complications in twin pregnancies are higher in emergency compared to elective cesarean deliveries and are also related to preexisting complications and earlier gestational age at delivery.

Puerperal morbidity following repeat cesarean delivery in twin pregnancies

OBJECTIVE

To evaluate the puerperal complications following twin deliveries.

STUDY DESIGN

We conducted a population-based analysis of puerperal delivery-related complications of twins born in Slovenia for comparing three groups of births (vaginal, elective and emergent cesarean).

RESULTS

A total of 1,001 elective, 1,109 emergent cesarean sections, and 2,204 vaginal twin births were evaluated. No differences were found between the complications after emergent and elective cesareans. Uterine atony was more frequent after vaginal births (OR 1.8-2.0, 95 % CI 1.1-1.2, 2.9-3.3). Vaginal births had a higher frequency of endometritis compared with elective cesarean (OR 4.1, 95 % CI 1.2, 13.6). Conversely, vaginal deliveries were less frequently associated with anemia, hematoma formation, and need for blood transfusion as compared to both modes of cesarean deliveries.

CONCLUSION

No solid data exist to show a clear advantage or disadvantage in terms of puerperal complications of an elective cesarean over vaginal birth for twins.

Puerperal complications following elective Cesarean sections for twin pregnancies

OBJECTIVE

To estimate the maternal puerperal morbidity in elective and emergent cesareans in twins.

STUDY DESIGN

We evaluated postpartum complications among patients who underwent elective cesarean birth for twin pregnancy. This group was compared to matched singletons and to emergent cesareans in twins.

RESULTS

During the period September 1994-March 2006 there were 299 (47.4%) elective and 80 (12.7%) emergent cesarean sections in twin pregnancies, for a total of 379 (60.1%) cesarean births for both twins. Controls included 299 cases of elective cesareans in singletons. The comparison between elective and emergent cesareans and between elective cesareans in twins and in singletons found no significant differences in postpartum fever, scar infection, and postpartum hemorrhage. Venous thromboembolism occurred in two twin pregnancies, one in the elective and one in the emergent cesarean group. Postpartum hysterectomy was required in a singleton pregnancy following an elective cesarean birth.

CONCLUSION

At present, no data exist to show a disadvantage for a planned cesarean birth for twins.

Cesarean delivery for twins: a systematic review and meta-analysis

OBJECTIVE

We undertook a systematic review and meta-analysis to determine whether a policy of planned cesarean section or vaginal delivery is better for twins.

STUDY DESIGN

We searched MEDLINE and EMBASE from 1980 through May 2001 using combinations of the following terms: twin, delivery, cesarean section, vaginal birth, birth weight, and gestational age. Studies that compared planned cesarean section to planned vaginal birth for babies weighing at least 1500 g or reaching at least 32 weeks' gestation were included. We computed pooled odds ratios for perinatal or neonatal mortality, low 5-minute Apgar score, neonatal morbidity, and maternal morbidity. The infant was the unit of statistical analysis. Results were considered statistically significant if the 95% CI did not encompass 1.0.

RESULTS

We retrieved 67 articles, 63 of which were excluded. Four studies with a total of 1932 infants were included in the analysis. A low 5-minute Apgar score occurred less frequently in twins delivered by planned cesarean section (odds ratio, 0.47; 95% CI, 0.26-0.88) principally because of a reduction among twins if twin A was in breech position (odds ratio, 0.33; 95% CI, 0.17-0.65). Twins delivered by planned cesarean section spent significantly longer in the hospital (mean difference, 4.01 days; 95% CI, 0.73-7.28 days). There were no significant differences in perinatal or neonatal mortality, neonatal morbidity, or maternal morbidity.

CONCLUSION

Planned cesarean section may decrease the risk of a low 5-minute Apgar score, particularly if twin A is breech. Otherwise, there is no evidence to support planned cesarean section for twins.

Frequency and significance of preterm delivery in twin pregnancies

OBJECTIVE

We investigated the frequency of preterm delivery and its influence on the neonatal outcome in twin pregnancies at a perinatal center. Are there differences in the course of twin pregnancies with preterm or term delivery?

METHOD

A retrospective investigation was carried out at the Department of Obstetrics on 502 twin pregnancies and deliveries between 1978 and 1993. Pregnancy history and clinical parameters were compared among preterm (<37+0 weeks) and term deliveries.

RESULT

Median duration of all twin pregnancies was 36+3 weeks of gestation. In the preterm group, preterm labor was more frequent, both, the first and the second neonate had lower birth weight and were more often admitted to the neonatal intensive care unit (NICU) where they stayed longer than full-term neonates needing intensive care. Perinatal deaths occurred only in the preterm group.

CONCLUSIONS

The incidence of preterm delivery is significantly elevated in twin pregnancies and consequently the incidence of low- and very-low-birth-weight-infants and perinatal mortality. Preterm delivery is the main reason why twin pregnancies are at a higher risk for an adverse neonatal outcome and thereby cause considerable costs.

Controversies in the intrapartum management of twin gestations

Advances in reproductive endocrine technology have helped to make twin gestations commonplace; however, as this article suggests, many unanswered questions and areas of controversy about the intrapartum management of twin gestations remain. Continued research in this area and the performance of prospective studies will shed further light on many of these topics.