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Am J Perinatol 2022; 39(06): 601-608
DOI: 10.1055/s-0040-1718368
Original Article

Rates of Cesarean Conversion and Associated Predictors and Outcomes in Planned Vaginal Twin Deliveries

Jenny Y. Mei 
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
,
Hector E. Muñoz
2   Department of Bioengineering, University of California, Los Angeles, California
,
Jessica S. Kim
3   Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California
,
Alec Szlachta-McGinn
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
,
Cinthia Blat
3   Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California
,
Rashmi Rao
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
,
Christina S. Han 
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
,
Roxanna A. Irani
4   Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California
,
Yalda Afshar 
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
› Institutsangaben Funding None.
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Abstract

Objective Twin vaginal deliveries (VDs) are often performed in the operating room (OR) given the risk of conversion to cesarean delivery (CD) for the aftercoming twin. We aim to investigate the rates of conversion to CD for planned twin VDs and identify predictors and outcomes of conversion.

Study Design A retrospective cohort study of all women who underwent a planned twin VD at two large academic medical centers over 4 years. Demographic and outcome data were chart abstracted. Various statistical tests were used to evaluate the influence of perinatal variables on mode of delivery and identify possible predictors of conversion.

Results Eight hundred and eighty-five twin deliveries were identified, of which 725 (81.9%) were possible candidates for VD. Of those, 237 (32.7%) underwent successful VD of twin A. Ninety-five (40.1%) had a nonvertex second twin at time of delivery. Conversion to CD occurred in 10 planned VDs (4.2%). Conversions were higher with spontaneous labor (relative risk [RR]: 2.1; 95% confidence interval [CI] 1.6–2.7; p = 0.003), and having an intertwin delivery interval greater than 60 minutes (RR: 5.1; 95% CI: 2.5–10.8; p < 0.001). Nonvertex presentation of twin B, type of delivery provider, or years out in practice of delivery provider were not significantly different between groups. There were no significant differences in neonatal outcomes between VD and conversion groups. There was a significant association between use of forceps for twin B and successful VD (p = 0.02), with 84.6% in the setting of a nonvertex twin B.

Conclusion Successful VD was achieved in planned VD of twins in 95.8% of cases, and there were no significant differences in maternal and fetal outcomes between successful VD and conversion to CD for twin B. With the optimal clinical scenario and shared decision-making, performing vaginal twin deliveries in labor and delivery rooms should be discussed.

Key Points

  • There is a propensity to perform twin vaginal deliveries in the operating room.

  • Rates of conversion to cesarean section are very low.

  • There are no significant differences in perinatal outcomes with conversion.

Keywords

twin vaginal deliveries - conversion to cesarean section - resource utilization - perinatal outcomes

Note

This study was presented in part in poster format at the Annual Clinical and Scientific Meeting of the American Congress of Obstetricians and Gynecologists from May 3 to 6, 2019, Nashville, Tennessee.




Publikationsverlauf

Eingereicht: 18. Juli 2020

Angenommen: 25. August 2020

Artikel online veröffentlicht:
08. Oktober 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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