title: A comparison of the neonatal morbidity of second twins to that of a low-risk population.
abstract: OBJECTIVE
  To assess the neonatal morbidity of second twins.
  
  
  METHODS
  Cohort study in a department of perinatalogy. The neonatal morbidity of second twins was compared to that of a low-risk population: singletons in the cephalic presentation delivered vaginally.
  
  
  RESULTS
  Five hundred fifty-nine second twins and 18,061 vaginally delivered singletons in the cephalic presentation were studied. Of 452 (81%) second twins delivered vaginally, 310 (69%) were extracted using obstetrical maneuvers: internal version and breech extraction, breech extraction alone, or assisted breech delivery if the breech was already engaged. Before 33 weeks of gestation, there was no significant difference between the neonatal morbidity of the vaginally delivered second twins and the vaginally delivered singletons in the cephalic presentation. After 33 weeks of gestation, only the 1-min Apgar score <7 and the rate of intubation at birth were significantly higher in the second twins. Whatever the gestational age, there was no significant difference between the neonatal morbidity of the vaginally delivered second twins and that of the second twins born by cesarean section before labor. At comparable gestational ages, there was no significant difference between the death rate of the vaginally delivered second twins and that in the reference population.
  
  
  CONCLUSIONS
  The neonatal morbidity of second twins was comparable to that of a low-risk population. Immediate management of the vaginally delivered second twins was, however, more intensive than that of vaginally delivered singletons in the cephalic presentation. It, therefore, requires appropriate equipment in a suitable obstetric-pediatric setting.
authors.affiliation: Department of Perinatalogy, Service de Gynécologie-Obstétrique, Hôpital Robert Debré, 48 Boulevard Sérurier, 75019, Paris, France. oliver.sibony@rdb.ap-hop-paris.fr
authors.forename: O
authors.initials: O
authors.lastname: Sibony
authors.forename: S
authors.initials: S
authors.lastname: Touitou
authors.forename: D
authors.initials: D
authors.lastname: Luton
authors.forename: J F
authors.initials: JF
authors.lastname: Oury
authors.forename: P H
authors.initials: PH
authors.lastname: Blot
mesh_terms: D001722:Birth Order; D001946:Breech Presentation; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007746:Labor Presentation; D009017:Morbidity; D009772:Obstetrical Forceps; D011247:Pregnancy; D012307:Risk Factors; D014427:Twins; D014710:Version, Fetal