The Maternal-Fetal Medicine Unit cesarean registry: trial of labor with a twin gestation.
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.


METHODS
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>or=34 weeks of gestation.


CONCLUSIONS
A trial of labor with twins after previous cesarean delivery does not appear to increase maternal morbidity. Perinatal morbidity is uncommon at>or=34 weeks of gestation.
Varner
Michael W
MW
Department of Obstetrics, University of Utah, Salt Lake City 84132, USA. mvarner@hsc.utah.edu
Leindecker
Sharon
S
Spong
Catherine Y
CY
Moawad
Atef H
AH
Hauth
John C
JC
Landon
Mark B
MB
Leveno
Kenneth J
KJ
Caritis
Steve N
SN
Harper
Margaret
M
Wapner
Ronald J
RJ
Sorokin
Yoram
Y
Miodovnik
Menachem
M
Carpenter
Marshall
M
Peaceman
Alan
A
O'Sullivan
Mary J
MJ
Sibai
Baha M
BM
Langer
Oded
O
Thorp
John M
JM
Ramin
Susan M
SM
Mercer
Brian M
BM
Gabbe
Steven G
SG
D000328:Adult; D002585:Cesarean Section; D005260:Female; D006801:Humans; D009316:National Institutes of Health (U.S.); D009774:Obstetrics; D011247:Pregnancy; D011272:Pregnancy, Multiple; D012042:Registries; D014219:Trial of Labor; D014427:Twins; D014481:United States; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data