Management of Dichorionic Twin Delivery at Term with Cephalic-Presenting First Twin - A Monocentric Retrospective Cohort Study

摘要

Objective: To assess neonatal outcome and delivery mode in dichorionic twin delivery at term with a cephalic-presenting first twin. Methods: A retrospective cohort study of 308 twin deliveries after 37 completed weeks of gestation with a cephalic-presenting first twin undertaken in one perinatal center with active management of second twin delivery. The neonatal outcome was measured by the Apgar score, the umbilical artery pH and the transfer into the neonatal unit. Results: In the whole group, 57% were vaginally delivered and 43% needed a Cesarean delivery. The planned vaginal delivery group contained 71 % while the planned elective Cesarean delivery group contained 29%. In the planned vaginal delivery group 80 % were delivered vaginally, in 15 % an emergency Cesarean was necessary, 5% had a vaginal delivery of the first twin followed by Cesarean delivery of the second twin. The neonatal outcome of the second twin shows a higher risk. There are significant differences in the rates of the second twin having lower rates of the umbilical artery pH > 7.20 in the group of planned vaginal delivery. The higher risks are compensated in the group of planned elective Cesarean delivery. Conclusions: Planned vaginal delivery of dichorionic twins at term and active second-stage management is associated with lower rate of normal neonatal outcome. These risks should be considered in prenatal informed consent discussions with the pregnant woman.