title: The effects of labor and delivery on maternal and neonatal outcomes in term twins: a retrospective cohort study.
abstract: OBJECTIVE
  To compare maternal and neonatal outcomes in twins undergoing a trial of labor versus pre-labor caesarean.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  19 US hospitals from the Consortium on Safe Labor.
  
  
  METHODS
  Of 2225 twin sets ≥36 weeks' gestation.
  
  
  METHODS
  Maternal (abruption, estimated blood loss, postpartum haemorrhage, transfusion, chorioamnionitis, hysterectomy, ICU admission, death) and neonatal outcomes (birth injury, 5-minute Apgar <7, NICU admission, RDS, TTN, sepsis, asphyxia, NICU length of stay, death) were compared between the trial of labour and pre-labour caesarean groups with univariate and multivariate logistic and linear regression analyses. Similar analyses were performed for actual delivery modes.
  
  
  METHODS
  Maternal and neonatal outcomes.
  
  
  RESULTS
  Among the 2225 twin sets, 1078 had a trial of labour, and 65.9% of those delivered vaginally. There was an increased risk for postpartum haemorrhage [OR 2.5, 95% confidence interval (CI) 1.4-4.5] and blood transfusion (OR 1.9, 95%CI 1.2-3.2) for the trial of labour compared with pre-labour caesarean groups. Birth injury only occurred in the trial of labour group, 1% Twin A, 0.4% Twin B. Both twins had a higher risk of 5-minute Apgar <7 with trial of labour compared to pre-labour caesarean (A: OR 3.9, 95%CI 1.05-14.5; B: OR 3.9, 95%CI 1.3-12.3).
  
  
  CONCLUSIONS
  Term twins undergoing a trial of labour have increased maternal haemorrhage and transfusions along with neonatal birth trauma and lower Apgar scores, but these absolute neonatal occurrences were rare. Trial of labour in twins remains a safe and reasonable option in appropriately selected cases.
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Wenckus
authors.forename: W
authors.initials: W
authors.lastname: Gao
authors.forename: M A
authors.initials: MA
authors.lastname: Kominiarek
authors.forename: I
authors.initials: I
authors.lastname: Wilkins
mesh_terms: D000328:Adult; D001720:Birth Injuries / Q000453:epidemiology*; D002585:Cesarean Section / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D014219:Trial of Labor; D014427:Twins; D014481:United States; D055815:Young Adult
keywords: caesarean; trial of labour; twins