title: Twin vaginal delivery is associated with lower umbilical arterial blood pH of the second twin and less intrapartum blood loss.
abstract: OBJECTIVE
  To clarify actual differences in the neonatal as well as maternal outcome between completed twin vaginal delivery and cesarean delivery.
  
  
  METHODS
  We collected the data from women with a twin pregnancy who delivered two live fetuses between 1 January and 31 December 2014 at 20 teaching hospitals (1) (1) PARTICIPANTS: Adachi Hospital, Hyogo Prefectural Amagasaki General Medical Center, Japan Baptist Hospital, Kitano Hospital, Kobe City Medical Center General Hospital, Kosaka Women's Hospital, Kurashiki Central Hospital, Kyoto University Hospital, Mitsubishi Kyoto Hospital, Nagahama Red Cross Hospital, National Hospital Organization Kyoto Medical Center, National Hospital Organization Osaka National Hospital, Osaka Red Cross Hospital, Otsu Municipal Hospital, Otsu Red Cross Hospital, Red Cross Wakayama Medical Center, Saiseikai Noe Hospital, Shizuoka General Hospital, Takamatsu Red Cross Hospital and Tenri Hospital. in Japan. Only the cases that were retrospectively regarded as eligible for planned vaginal delivery were analyzed according to the actual mode of delivery.
  
  
  RESULTS
  Umbilical arterial blood pH (UmA-pH) of the second twin was slightly but significantly lower in the vaginal delivery group (7.26 ± 0.009) than in a cesarean delivery group (7.30 ± 0.006). Vaginal delivery was the only independent risk factor for second twin's UmA-pH  <7.20. Intrapartum blood loss was significantly larger in the cesarean delivery group (1444 ± 63 g) than in the vaginal delivery group (820 ± 109 g). Cesarean delivery was an independent risk factor for intrapartum blood loss ≥1500 g.
  
  
  CONCLUSIONS
  Twin vaginal deliveries were associated with slightly but significantly lower UmA-pH of the second twin, whereas twin cesarean delivery was associated with significantly larger intrapartum blood loss. Not only the neonatal risk but also the maternal risk should be taken into account when an optimal delivery mode for the twin pregnancy is considered.
authors.affiliation: a Department of Obstetrics and Gynecology , Otsu Red Cross Hospital , Otsu , Japan and.
authors.forename: Yukiyasu
authors.initials: Y
authors.lastname: Sato
authors.affiliation: a Department of Obstetrics and Gynecology , Otsu Red Cross Hospital , Otsu , Japan and.
authors.forename: Ikuko
authors.initials: I
authors.lastname: Emoto
authors.affiliation: a Department of Obstetrics and Gynecology , Otsu Red Cross Hospital , Otsu , Japan and.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Maruyama
authors.affiliation: a Department of Obstetrics and Gynecology , Otsu Red Cross Hospital , Otsu , Japan and.
authors.forename: Atsuko
authors.initials: A
authors.lastname: Taga
authors.affiliation: b Department of Obstetrics and Gynecology , Kyoto Katsura Hospital , Kyoto , Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Fujii
mesh_terms: D000328:Adult; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D005312:Fetal Blood / Q000737:chemistry*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007231:Infant, Newborn; D007564:Japan; D006473:Postpartum Hemorrhage / Q000503:physiopathology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D059285:Pregnancy, Twin / Q000502:physiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014427:Twins
keywords: Cesarean section; morbidity; mortality; multicenter retrospective cohort study; twin pregnancy