title: Vaginal birth after cesarean (VBAC) attempt in twin pregnancies: is it safe?
abstract: OBJECTIVE
  The purpose of this study was to compare the rate of vaginal birth after cesarean (VBAC) attempt, VBAC failure, and major maternal adverse outcomes in women with a previous cesarean with twin or singleton pregnancies.
  
  
  METHODS
  This was a multicenter retrospective cohort study between the years 1996 and 2000. Subjects were identified by ICD-9 code. Trained research nurses collected medical record data on the outcome of VBAC attempts, and clinical outcomes, including uterine rupture and major operative injuries. We used bivariate and multivariable techniques to assess the association between twins and the outcomes.
  
  
  RESULTS
  Of 25,005 patients with at least 1 previous cesarean, there were 535 twin pregnancies and 24,307 singleton pregnancies. Compared with patients with singleton gestations, patients with twins were less likely to attempt a VBAC (adjusted odds ratio [AOR] 0.3, 95% CI 0.2-0.4), but no more likely to have a VBAC failure (AOR 1.1, 95% CI 0.8-1.6), a uterine rupture (AOR 1.2, 95% CI 0.3-4.6), or a major maternal morbidity (AOR 1.6, 95% CI 0.7-3.7).
  
  
  CONCLUSIONS
  Women with twin gestations are less likely to attempt a VBAC, but they are no more likely to fail a VBAC trial or experience a major morbid event compared with women with singleton gestations.
authors.affiliation: Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, USA. acahill@mail.obgyn.upenn.edu
authors.forename: Alison
authors.initials: A
authors.lastname: Cahill
authors.forename: David M
authors.initials: DM
authors.lastname: Stamilio
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Paré
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Peipert
authors.forename: Erika J
authors.initials: EJ
authors.lastname: Stevens
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Nelson
authors.forename: George A
authors.initials: GA
authors.lastname: Macones
mesh_terms: D000328:Adult; D017604:Cesarean Section, Repeat; D005260:Female; D006801:Humans; D016015:Logistic Models; D011247:Pregnancy; D011272:Pregnancy, Multiple; D012189:Retrospective Studies; D014427:Twins; D014597:Uterine Rupture / Q000453:epidemiology; D016064:Vaginal Birth after Cesarean