title: Trial of labour compared to elective Caesarean in twin gestations with a previous Caesarean delivery.
abstract: OBJECTIVE
  To compare maternal and neonatal outcomes in twin gestations with a vertex presenting first twin undergoing either an elective repeat Caesarean section or a trial of labour subsequent to having had a Caesarean delivery in a prior pregnancy.
  
  
  METHODS
  Maternal and newborn data from 1980 to 1999 in twin gestations, having 1 or more previous lower-segment Caesarean section(s) and a vertex presentation of the first twin, were analyzed from the Nova Scotia Atlee Perinatal Database. Categorical data were compared using chi-square or Fisher exact tests and continuous data by the Student t test. Logistic regression was used to control for covariates.
  
  
  RESULTS
  Of the 121 women eligible for the data analysis, 38 chose to have a trial of labour, and 28 delivered vaginally with no uterine ruptures, scar dehiscences, maternal deaths, or increase in neonatal morbidity or mortality reported. Two Caesareans in the trial-of-labour group were for the delivery of the second twin. Women choosing elective Caesarean section had a higher incidence of infectious morbidity (p = 0.04).
  
  
  CONCLUSIONS
  In twin pregnancies with twin A presenting as a vertex, a cautious trial of labour may be an effective and safe alternative to elective repeat Caesarean section. Further research on a trial of labour after previous Caesarean section in twin gestations is warranted, as the studies published to date do not have sufficiently large numbers to detect adverse maternal and neonatal outcomes.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS, Canada.
authors.forename: Tina
authors.initials: T
authors.lastname: Delaney
authors.forename: David C
authors.initials: DC
authors.lastname: Young
mesh_terms: D002585:Cesarean Section; D017604:Cesarean Section, Repeat; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D007746:Labor Presentation; D011247:Pregnancy; D011256:Pregnancy Outcome; D014219:Trial of Labor; D014427:Twins; D016064:Vaginal Birth after Cesarean