Impacts of Operative Delivery for the First Twin on Neonatal Outcomes in the Second Twin

Qiuying Yang; Mark C. Walker; Xi Kuan Chen; Daniel Krewski; Karen Fung Kee Fung; Shi Wu Wen

doi:10.1055/s-2006-951286

American Journal of Perinatology, Table of Contents

Am J Perinatol 2006; 23(7): 381-386
DOI: 10.1055/s-2006-951286

Impacts of Operative Delivery for the First Twin on Neonatal Outcomes in the Second Twin

Qiuying Yang¹ ^, ² , Mark C. Walker¹ , Xi Kuan Chen¹ , Daniel Krewski² , Karen Fung Kee Fung³ , Shi Wu Wen¹

¹OMNI Research Group, Ottawa Health Research Institute, Ottawa, Canada
²McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health, University of Ottawa, Ottawa, Canada
³Division of Maternal-Fetal Medicine, University of Ottawa, Ottawa, Canada

Abstract

ABSTRACT

We assess the impacts of operative delivery for the first twins with vertex presentation on neonatal outcomes in second twins using the 1995 to 1997 twin registry data of the United States. A total of 102,554 eligible twin pairs with vertex presentation for the first twin were included in the analysis. Of these, 50,748 (49.5%) first twins had a normal vaginal delivery, 43,504 (42.4%) were delivered by cesarean section, and 8302 (8.1%) were delivered by vaginal operation (vacuum extraction or forceps). In term twins, the risks of asphyxia-related mortality (odds ratio [OR], 3.08; 95% CI, 1.07 to 8.45), newborn injury (OR, 2.10; 95% 1.39 to 3.12), low Apgar score at 5 minutes (OR, 1.49; 95% 1.24 to 1.78), and mechanical ventilation use (OR, 1.34; 95% 1.20 to 1.51) were increased in the second twins whose co-twins were delivered by vaginal operation compared with those whose co-twins who had normal vaginal delivery. In contrast, the risks of asphyxia-related mortality (OR, 0.55; 95% 0.17 to 1.57), newborn injury (OR, 0.20; 95% 0.11 to 0.34), low Apgar score at 5 minutes (OR, 0.51; 95% 0.44 to 0.60), and mechanical ventilation use (OR, 0.77; 95% 0.71 to 0.83) were decreased in the second twins whose co-twins were delivered by cesarean section compared with those whose co-twins had a normal vaginal delivery. In conclusion, vaginal operative delivery for the first twins is related to the adverse neonatal outcomes of their co-twins, whereas cesarean delivery for the first twins is associated with the beneficial neonatal outcomes of their co-twins.

KEYWORDS

Twin - delivery - neonatal outcomes

Full Text

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Qiuying YangM.D. Ph.D.

OMNI Research Group, Ottawa Health Research Institute

501 Smyth Road, Ottawa, Canada, K1H 8L6