title: Twin delivery after a previous caesarean: a twelve-year experience.
abstract: OBJECTIVE
  To compare maternal and neonatal morbidities between trial of labour (TOL) and elective Caesarean section in women with twin pregnancies who have had a prior Caesarean.
  
  
  METHODS
  An observational study was conducted of women with a prior Caesarean who delivered twins at 28 weeks  gestation or greater in Ste-Justine Hospital between 1988 and 2001. Maternal and neonatal outcomes were compared between women who had a TOL (group 1) and those who had an elective Caesarean delivery (group 2).
  
  
  RESULTS
  Twenty-six women and 52 fetuses were included in group 1 and compared to the 71 women and 142 fetuses in group 2. Maternal age, gestational age, and birth weight were comparable in both groups. In group 1, 22 (85%) out of 26 women delivered twin A vaginally and 19 (73%) delivered both vaginally. There was no significant difference in the umbilical artery cord pH, Apgar score, ventilatory support, and admission to the neonatal intensive care unit between the 2 groups. There was also no significant difference in the rate of postpartum maternal fever or decrease of serum hemoglobin between the 2 groups, but the median hospital stay was higher in the group with elective Caesarean (5.0 vs. 3.0 days, p <0.001). There were no uterine ruptures or other major complications in either group.
  
  
  CONCLUSIONS
  There were no significant differences in maternal and neonatal morbidity outcomes between births by trial of labour and by elective Caesarean, in twin pregnancies after a prior Caesarean section. A trial of labour is associated with a shorter hospital stay.
authors.affiliation: Department of Obstetrics and Gynecology, Ste-Justine Hospital, University of Montreal, Montreal, QC, Canada.
authors.forename: Andrée
authors.initials: A
authors.lastname: Sansregret
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Bujold
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Gauthier
mesh_terms: D000328:Adult; D017604:Cesarean Section, Repeat; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007746:Labor Presentation; D007902:Length of Stay; D009017:Morbidity; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D014219:Trial of Labor; D014427:Twins; D016064:Vaginal Birth after Cesarean