title: Intrapartum management of twin pregnancies: are uncomplicated monochorionic pregnancies more at risk of complications than dichorionic pregnancies?
abstract: OBJECTIVE
  To analyze mode of delivery and neonatal morbidity according to chorionicity in a hospital birth center with a policy of vaginal delivery for twins.
  
  
  METHODS
  Retrospective analysis over a 13-year period.
  
  
  METHODS
  Department of Obstetrics, University Hospital, Lille, France.
  
  
  METHODS
  In all, 1009 twin pregnancies were included, divided into 171 uncomplicated monochorionic pregnancies (17%) and 838 dichorionic pregnancies (83%).
  
  
  METHODS
  We compared the monochorionic and the dichorionic populations.
  
  
  METHODS
  Rate of cesarean section and neonatal outcome (umbilical artery pH, Apgar score and neonatal complications).
  
  
  RESULTS
  The rate of cesarean sections was 45.7% with no difference found based on chorionicity. The reasons for elective cesarean section were mainly noncephalic presentation, which was more frequent in dichorionic than in monochorionic (48.8% vs. 37.2%, p = 0.025) pregnancies. Birthweight was lower in monochorionic twins (2249 ± 469 g vs. 2329 ± 478 g, p = 0.045). The rate of umbilical artery cord blood values with a pH < 7.10 was similar in monochorionic and dichorionic pregnancies. There was no difference in neonatal complications between the two groups.
  
  
  CONCLUSIONS
  Monochorionic and dichorionic twin pregnancies had similar delivery outcomes. The neonatal outcome for twin 2 was not different between monochorionic and dichorionic pregnancies. Vaginal birth could be offered to women with twin pregnancies regardless of chorionicity.
authors.affiliation: Department of Obstetrics, Jeanne de Flandre Hospital, Lille, France; Unit EA 4489 Perinatal Environment and Growth, Faculty of Medicine, Henri-Warembourg, University of Lille, Lille, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Garabedian
authors.forename: Chloe
authors.initials: C
authors.lastname: Poulain
authors.forename: Alain
authors.initials: A
authors.lastname: Duhamel
authors.forename: Damien
authors.initials: D
authors.lastname: Subtil
authors.forename: Veronique
authors.initials: V
authors.lastname: Houfflin-Debarge
authors.forename: Philippe
authors.initials: P
authors.lastname: Deruelle
mesh_terms: D001724:Birth Weight; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D005602:France; D006801:Humans; D007751:Labor, Induced / Q000706:statistics & numerical data; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D018743:Perinatal Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011263:Pregnancy Trimester, Third; D018566:Pregnancy, High-Risk; D059285:Pregnancy, Twin / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Chorionicity; cesarean section; mode of delivery; morbidity; perinatal mortality; pregnancy; twin