Twin delivery: method, timing and conduct.
The incidence of twin pregnancy has increased worldwide over the past 10 years, largely as a consequence of the assisted reproductive technologies. Issues such as intrapartum monitoring and operative interventions, especially relating to the second twin, provide a unique challenge in labour and delivery. Epidemiological and cohort data suggest that twins have a three-fold higher mortality rate than singletons, and that the second twin might have a better outcome if delivered by lower segment caesarean section. The recently completed Twin Birth Study has found that planned vaginal lower segment caesarean section is not advantageous to the fetus. In the light of this large randomised-controlled trial, vaginal delivery if twin A presents by the vertex is recommended as long as guidelines for the conduct of such delivery are followed.
Professor and Chief of Maternal Fetal Medicine, University of Toronto, Sunnybrook Health Science Centre, Aubrey and Marla Dan Program, 2075 Bayview Ave, M4 - 172, Toronto M4N 3M5, Canada. Electronic address: jon.barrett@sunnybrook.ca.
Jon F R
JF
Barrett
D001946:Breech Presentation; D002170:Canada / Q000453:epidemiology; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D059285:Pregnancy, Twin; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014427:Twins / Q000706:statistics & numerical data
Twin Birth Study; epidural in twin delivery; the non-vertex second twin; time interval in twin delivery; twin caesarean section; twin gestation; twin pregnancy; vaginal delivery in twins