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Clinical Factors Associated With Presentation Change of the Second Twin After Vaginal Delivery of the First Twin

Panelli, Danielle M. MD; Easter, Sarah Rae MD; Bibbo, Carolina MD; Robinson, Julian N. MD; Carusi, Daniela A. MD, MSc

doi: 10.1097/AOG.0000000000002329
Contents: Original Research

OBJECTIVE: To identify clinical factors associated with a change from vertex to nonvertex presentation in the second twin after vaginal birth of the first.

METHODS: We assembled a retrospective cohort of women with viable vertex–vertex twin pregnancies who delivered the presenting twin vaginally. Women whose second twin changed from vertex to nonvertex after vaginal birth of the first were classified as experiencing an intrapartum change in presentation. Characteristics associated with intrapartum presentation change in a univariate analysis with a P value ≤.10 were then evaluated in a multivariate logistic regression model.

RESULTS: Four-hundred fifty women met inclusion criteria, of whom 55 (12%) had intrapartum presentation change of the second twin. Women experiencing intrapartum presentation change were more likely to be multiparous (69% compared with 47%, P<.01) and to have had a change in the presentation of the second twin between the most recent antepartum ultrasonogram and the ultrasonogram done on admission to labor and delivery (11% compared with 4%, P=.04). In an adjusted analysis, multiparity and gestational age less than 34 weeks were significantly associated with presentation change (adjusted odds ratio [OR] 2.9, 95% CI 1.5–5.6 and adjusted OR 2.6, 95% CI 1.1–5.9, respectively). Women with intrapartum presentation change were more likely to undergo cesarean delivery for their second twin (44% compared with 7%, P<.01) with an adjusted OR of 10.50 (95% CI 5.20–21.20) compared with those with stable intrapartum presentation. Twenty of the 24 (83%) cesarean deliveries performed in the intrapartum presentation change group were done for issues related to malpresentation.

CONCLUSION: Multiparity and gestational age less than 34 weeks are associated with intrapartum presentation change of the second twin.

In women laboring with vertex–vertex twins, multiparity and gestational age less than 34 weeks are risk factors for presentation change of the second twin.

Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Corresponding author: Danielle M. Panelli, MD, Brigham and Women's Hospital, Division of Maternal-Fetal Medicine, 75 Francis Street, Boston, MA 02115; email: dpanelli@partners.org.

Supported in part by Expanding the Boundaries Faculty Grant from Brigham and Women’s Hospital.

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented as poster at the 37th Annual Pregnancy Meeting for the Society for Maternal-Fetal Medicine, January 23–28, 2017, Las Vegas, Nevada.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.