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Neonatal Outcomes of Twin Pregnancy According to the Planned Mode of Delivery

Schmitz, Thomas MD1,2; Carnavalet, Céline de Carné MD1,2; Azria, Elie MD1,2; Lopez, Emmanuel MD2,3; Cabrol, Dominique MD, PhD1,2; Goffinet, François MD, PhD1,2,4

doi: 10.1097/AOG.0b013e318163c435
Original Research

OBJECTIVES: To assess neonatal morbidity in twin pregnancy according to the planned mode of delivery.

METHODS: A retrospective cohort study of 758 consecutive sets of twins born after 35 weeks of gestation with a cephalic-presenting first twin was undertaken in a level III maternity unit in which active management of the second twin delivery is performed routinely. The primary outcome was a composite measure of neonatal mortality and morbidity, including pH less than 7.0, 5-minute Apgar score less than 4, neonatal intensive care unit transfer more than 4 days, pneumothorax, and fracture. Control for potential confounders was performed by excluding from the analysis women who experienced pregnancy complications and by using logistic regression models.

RESULTS: Vaginal or cesarean delivery was planned for 657 (86.7%) and 101 (13.3%) women, respectively. Among planned vaginal deliveries, 515 (78.4%) patients delivered both twins vaginally, 139 (21.1%) had a cesarean delivery during labor, and 3 (0.5%) had cesarean delivery for the second twin. After vaginal birth of the first twin, the mean intertwin delivery interval was 4.9±3.2 minutes. When patients who experienced pregnancy complications were excluded (n=202), the neonatal composite morbidity for the second twin did not differ between planned cesarean and planned vaginal delivery (5.0% compared with 4.7%, adjusted odds ratio 1.5, 95% confidence interval 0.3–7.4, P=.63). Neonatal composite morbidity of first twins did not differ between groups.

CONCLUSION: For twin gestations with a cephalic-presenting first twin, planned vaginal delivery after 35 weeks of gestation in selected women remains a safe option in centers used to active management of the second twin delivery.


Planned vaginal delivery with active management of the second twin after 35 weeks of gestation in selected women remains a safe option.

From the 1Maternité Port-Royal, Hôpital Cochin, AP-HP; 2Université Paris Descartes; 3Service de Médecine Néonatale de Port-Royal, Hôpital Cochin, AP-HP; and 4INSERM U149, Hôpital Saint-Vincent-de-Paul, Paris, France.

Corresponding author: Dr. Thomas Schmitz, Maternité Port-Royal, 123 Boulevard de Port-Royal, 75014 Paris, France; e-mail:

Financial Disclosure The authors have no potential conflicts of interest to disclose.

© 2008 The American College of Obstetricians and Gynecologists