title: Safety of vaginal delivery among dichorionic diamniotic twins over 10 years in a UK teaching hospital.
abstract: OBJECTIVE
  To determine whether vaginal delivery among dichorionic diamniotic twins remains a safe option following full implementation of the European Working Time Directive in the UK.
  
  
  METHODS
  A retrospective study was conducted using data for women with dichorionic diamniotic twin pregnancies who attended a teaching hospital in London, UK, for delivery between January 4, 2000, and December 23, 2010.
  
  
  RESULTS
  Among 892 women, 474 (53.1%) attempted vaginal delivery, 220 (46.4%) of whom achieved spontaneous vaginal delivery of both twins. Instrumental vaginal delivery was performed among 89 women (18.8%), and 165 (34.8%) women underwent emergency cesarean delivery. Delivery of the second twin by emergency cesarean (n=31) was predominantly for fetal distress (13 [41.9%]) or abnormal lie (10 [32.3%]). A 5-minute Apgar score of 9 or 10 was recorded for 384 (83.7%) of 459 first twins and 369 (82.9%) of 445 second twins, irrespective of the mode of delivery.
  
  
  CONCLUSIONS
  Vaginal delivery among dichorionic diamniotic twins had a good success rate and a low intrapartum emergency cesarean delivery rate. Training in cardiotocography and intrapartum procedures might further reduce the need for emergency cesarean delivery.
authors.affiliation: Obstetrics and Gynaecology, University Hospital of Wales, Cardiff, UK.
authors.forename: Ewelina
authors.initials: E
authors.lastname: Rzyska
authors.affiliation: Obstetrics and Gynaecology, Croydon University Hospital, London, UK.
authors.forename: Bini
authors.initials: B
authors.lastname: Ajay
authors.affiliation: Labour Ward, St. George's University Hospitals NHS Foundation Trust, London, UK.
authors.forename: Edwin
authors.initials: E
authors.lastname: Chandraharan
mesh_terms: D000328:Adult; D001034:Apgar Score; D015148:Cardiotocography / Q000379:methods; D002585:Cesarean Section / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric / Q000502:physiology*; D008131:London; D036801:Parturition; D011247:Pregnancy; D059285:Pregnancy, Twin / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors
keywords: Cardiotocography; Cesarean delivery; Dichorionic diamniotic twins; Internal podalic version; Training; Vaginal delivery