American Journal of Obstetrics & Gynecology
Volume 193, Issue 1 , Pages 135-140, July 2005

The Maternal-Fetal Medicine Unit cesarean registry: Trial of labor with a twin gestation

  • Michael W. Varner, MD

      Affiliations

    • Departments of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
    • Corresponding Author InformationReprint requests: Michael W. Varner, MD, Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 North 1900 East, Room 308, Salt Lake City, UT 84132.
    • ,
  • Sharon Leindecker, MS

      Affiliations

    • The George Washington University Biostatistics Center, Washington, DC
    • ,
  • Catherine Y. Spong, MD

      Affiliations

    • National Institute of Child Health and Human Development, Bethesda, MD
    • ,
  • Atef H. Moawad, MD

      Affiliations

    • University of Chicago, Chicago, IL
    • ,
  • John C. Hauth, MD

      Affiliations

    • University of Alabama at Birmingham, Birmingham, AL
    • ,
  • Mark B. Landon, MD

      Affiliations

    • Ohio State University, Columbus, OH
    • ,
  • Kenneth J. Leveno, MD

      Affiliations

    • University of Texas–Southwestern, Dallas, TX
    • ,
  • Steve N. Caritis, MD

      Affiliations

    • University of Pittsburgh, Pittsburgh, PA
    • ,
  • Margaret Harper, MD

      Affiliations

    • Wake Forest University, Winston-Salem, NC
    • ,
  • Ronald J. Wapner, MD

      Affiliations

    • Thomas Jefferson University, Philadelphia, PA
    • ,
  • Yoram Sorokin, MD

      Affiliations

    • Wayne State University, Detroit, MI
    • ,
  • Menachem Miodovnik, MD

      Affiliations

    • University of Cincinnati, Cincinnati, OH
    • Columbia University, New York, NY
    • ,
  • Marshall Carpenter, MD

      Affiliations

    • Brown University, Providence, RI
    • ,
  • Alan Peaceman, MD

      Affiliations

    • Northwestern University, Chicago, IL
    • ,
  • Mary J. O'Sullivan, MD

      Affiliations

    • University of Miami, Miami, FL
    • ,
  • Baha M. Sibai, MD

      Affiliations

    • University of Tennessee, Memphis, TN
    • ,
  • Oded Langer, MD

      Affiliations

    • University of Texas–San Antonio, San Antonio, TX
    • ,
  • John M. Thorp, MD

      Affiliations

    • University of North Carolina at Chapel Hill, Chapel Hill, NC
    • ,
  • Susan M. Ramin, MD

      Affiliations

    • University of Texas–Houston, Houston, TX
    • ,
  • Brian M. Mercer, MD

      Affiliations

    • Case Western Reserve University, Cleveland, OH
    • ,
  • Steven G. Gabbe, MD

      Affiliations

    • Vanderbilt University, Nashville, TN
    • ,
  • for the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network

Received 1 November 2004; received in revised form 2 March 2005; accepted 7 March 2005.

Objective

The purpose of this study was to identify the success rates and risks in women with a twin pregnancy who attempt a trial of labor after cesarean delivery.

Study design

Cases were identified in the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network's Cesarean Registry with a woman with a twin pregnancy who had had at least 1 previous cesarean delivery.

Results

During the study period (1999-2002), 412 women fulfilled the study criteria, and 226 women had elective repeat cesarean delivery. Of the 186 women (45.1% of total) who attempted a trial of labor, 120 women were delivered successfully (success rate, 64.5%), and 66 women (35.5%) had a failed trial of labor. Thirty of the failed trials of labor involved a vaginal delivery for twin A and cesarean delivery for twin B. Women who attempted a trial of labor with twins had no increased risk of transfusion, endometritis, intensive care unit admissions, or uterine rupture when compared with elective repeat cesarean delivery. Fetal and neonatal complications were uncommon in either group at ≥34 weeks of gestation.

Conclusion

A trial of labor with twins after previous cesarean delivery does not appear to increase maternal morbidity. Perinatal morbidity is uncommon at ≥34 weeks of gestation.

Key words: Trial of labor, Twins, Previous cesarean delivery

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 Supported by grants from the National Institute of Child Health and Human Development: HD21410, HD 21414, HD27860, HD27861, HD, 27869, HD 27883, HD 27889, HD, 27905, HD, 27915, HD 27917, HD 34116, HD34122, HD34136, HD34208, HD34210, HD34136, HD40500, HD 40485, HD40544, HD40545, HD40560, HD40512, HD19897 and HD36801.Presented at the annual meeting of the Society for Gynecologic Investigation, Houston, Texas, March 24-27, 2004.

PII: S0002-9378(05)00413-8

doi:10.1016/j.ajog.2005.03.023

American Journal of Obstetrics & Gynecology
Volume 193, Issue 1 , Pages 135-140, July 2005

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