title: Active second-stage management in twin pregnancies undergoing planned vaginal delivery in a U.S. population.
abstract: OBJECTIVE
  To estimate neonatal morbidity and delivery outcomes according to planned mode of delivery in twin pregnancies with active second-stage management.
  
  
  METHODS
  This was an historic cohort of twin pregnancies delivered in one practice between June 2005 and September 2009 using a strict protocol of second-stage management, including breech extraction of a second noncephalic twin and internal version of a nonengaged cephalic second twin followed by breech extraction. Primary outcome was a 5-minute Apgar score less than 7 for twin B. Secondary outcomes were 5-minute Apgar score less than 7 for twin A and 1-minute Apgar score less than 7 and arterial cord pH below 7.20 for each twin.
  
  
  RESULTS
  A total of 287 twin pregnancies were included. There were 157 patients (54.7%) in the planned cesarean group and 130 patients (45.3%) in the planned vaginal delivery group. There was no significant difference in the rates of twin B having a 5-minute Apgar score lower than 7 or an arterial cord pH below 7.20. Among the patients in the planned vaginal delivery group, the cesarean delivery rate was 15.4%. No patients had a vaginal delivery of twin A followed by cesarean delivery of twin B. Among the patients in the planned vaginal delivery group, patients who had a successful vaginal delivery were more likely to be younger (31.56+/-6.6 compared with 36.88+/-6.1 years, P=.001) and were more likely to have a prior vaginal delivery (47.3% compared with 15.0%, P=.007).
  
  
  CONCLUSIONS
  Planned vaginal delivery of twin pregnancies seems to be associated with neonatal outcomes similar to those with planned cesarean delivery. Active second-stage management is associated with good neonatal outcomes and a low risk of combined vaginal-cesarean delivery.
  
  
  METHODS
  II.
authors.affiliation: From Maternal Fetal Medicine Associates, PLLC, and the Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai School of Medicine, New York, New York.
authors.forename: Nathan S
authors.initials: NS
authors.lastname: Fox
authors.forename: Michael
authors.initials: M
authors.lastname: Silverstein
authors.forename: Samuel
authors.initials: S
authors.lastname: Bender
authors.forename: Chad K
authors.initials: CK
authors.lastname: Klauser
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Saltzman
authors.forename: Andrei
authors.initials: A
authors.lastname: Rebarber
mesh_terms: D000328:Adult; D001034:Apgar Score; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007746:Labor Presentation; D007748:Labor Stage, Second; D011247:Pregnancy; D014427:Twins; D014710:Version, Fetal