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
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Article info
Publication history
Accepted:
March 7,
2005
Received in revised form:
March 2,
2005
Received:
November 1,
2004
Footnotes
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.
Identification
Copyright
© 2005 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
