title: The Maternal-Fetal Medicine Unit cesarean registry: trial of labor with a twin gestation.
abstract: 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.
authors: Department of Obstetrics, University of Utah, Salt Lake City 84132, USA. mvarner@hsc.utah.edu
authors: Michael W
authors: MW
authors: Varner
authors: Sharon
authors: S
authors: Leindecker
authors: Catherine Y
authors: CY
authors: Spong
authors: Atef H
authors: AH
authors: Moawad
authors: John C
authors: JC
authors: Hauth
authors: Mark B
authors: MB
authors: Landon
authors: Kenneth J
authors: KJ
authors: Leveno
authors: Steve N
authors: SN
authors: Caritis
authors: Margaret
authors: M
authors: Harper
authors: Ronald J
authors: RJ
authors: Wapner
authors: Yoram
authors: Y
authors: Sorokin
authors: Menachem
authors: M
authors: Miodovnik
authors: Marshall
authors: M
authors: Carpenter
authors: Alan
authors: A
authors: Peaceman
authors: Mary J
authors: MJ
authors: O'Sullivan
authors: Baha M
authors: BM
authors: Sibai
authors: Oded
authors: O
authors: Langer
authors: John M
authors: JM
authors: Thorp
authors: Susan M
authors: SM
authors: Ramin
authors: Brian M
authors: BM
authors: Mercer
authors: Steven G
authors: SG
authors: Gabbe
mesh_terms: 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