Twin vaginal delivery is associated with lower umbilical arterial blood pH of the second twin and less intrapartum blood loss.
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.


CONCLUSION
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.
['Sato|Yukiyasu|Y|', 'Emoto|Ikuko|I|', 'Maruyama|Shunsuke|S|', 'Taga|Atsuko|A|', 'Fujii|Tsuyoshi|T|']
D000328:Adult D002585:Cesarean Section D036861:Delivery, Obstetric D005260:Female D005312:Fetal Blood D006801:Humans D006863:Hydrogen-Ion Concentration D007231:Infant, Newborn D007564:Japan D006473:Postpartum Hemorrhage D011247:Pregnancy D011256:Pregnancy Outcome D059285:Pregnancy, Twin D012189:Retrospective Studies D012307:Risk Factors D014427:Twins
twin pregnancy Cesarean section morbidity mortality multicenter retrospective cohort study