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To assess neonatal mortality and morbidity of cephalic second twins according to the obstetrical strategy adopted after vaginal birth of the first twin, either internal version followed by total breech extraction, as recommended by the French College of Gynecologists and Obstetricians, or pushing efforts.
In this planned secondary analysis of the JUMODA cohort, a national prospective population-based study of twin deliveries conducted from 02/2014 to 03/2015 in 176 hospitals performing more than 1,500 annual deliveries in France, we included cephalic second twins after vaginal birth of the first twin at 32 weeks and more. Intrauterine fetal deaths, fetal malformations, twin-to-twin transfusion syndromes, monoamniotic pregnancies, and unknown presentations and managements of second twins were excluded. The primary outcome was a composite of neonatal mortality and morbidity. To control for potential confounders, we used multivariate Poisson regression models.
Of 2261 cephalic second twins included in the study, 494 (21.8%) were born in breech presentation after internal version and total breech extraction and 1767 (78.2%) in cephalic presentation after pushing efforts. The mean inter-twin delivery interval was shorter in the internal version group compared to the pushing efforts group (6.6 ± 5.9 versus 10.0 ± 13.0, p<0.01). Neither rates of cesarean for the second twin (10/494 (2.0%) versus 61/1767 (3.2%), p=0.1) nor rates of composite neonatal mortality and morbidity (17/494 (3.4%) versus 36/1767 (2.2%); aRR 1.4, 95% CI 0.8-2.4) differed significantly between the two groups.
Compared with pushing efforts after vaginal birth of the first twin, internal version followed by total breech extraction of cephalic second twins is associated with shorter inter-twin delivery intervals but not with improved neonatal outcomes.