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Obstetrics & Gynecology 2004;103:413-419
© 2004 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Occurrence and Predictors of Cesarean Delivery for the Second Twin After Vaginal Delivery of the First Twin

Shi Wu Wen, MB, PhD, Karen Fung Kee Fung, MD, Lawrence Oppenheimer, MD, Kitaw Demissie, MD, PhD, Qiuying Yang, MD, PhD and Mark Walker, MD

From the OMNI Research Group, Division of Maternal-Fetal Medicine, University of Ottawa, Faculty of Medicine, Ottawa, Canada; Ottawa Health Research Institute, Ottawa, Canada; Division of Maternal-Fetal Medicine, University of Ottawa, Faculty of Medicine, Ottawa, Canada; Division of Epidemiology, School of Public Health, University of Medicine and Dentistry of New Jersey, Piscataway, New Jersey; and McLauphlin Centre for Population Health Risk Assessment, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada.

Address reprint requests to: Dr. Shi Wu Wen, OMNI Research Group, Department of Obstetrics and Gynecology, The Ottawa Hospital, General Campus, 501 Smyth Road, Box 241, Ottawa, Canada, K1H 8L6; e-mail: swwen{at}ohri.ca.

OBJECTIVE: To estimate the occurrence and to assess clinical predictors of emergent cesarean delivery in the second twin after vaginal delivery of the first twin.

METHODS: We conducted a population-based cohort study, using the 1995–1997 linked mother/infant twin data from the United States. The adjusted risk ratios and population attributable risks of clinical predictors of emergent cesarean delivery in second twins were estimated for the overall study sample and for those born at less than 36 or 36 weeks or more of gestation.

RESULTS: Among the 61,845 second twin births with the first twin delivered vaginally, 5,842 (9.45%) were delivered by cesarean. The cesarean delivery rate was increased in infants born to mothers with medical or labor and delivery complications. Breech and other malpresentations were the most important predictors of emergent cesarean delivery for the second twin (population attributable risk 33.2%; 95% confidence interval 31.8%, 34.6%). Operative vaginal delivery of the first twin was associated with a decreased risk of cesarean delivery for the second twin. Prediction of emergent cesarean for the second twin by clinical factors was stronger in term births than preterm births.

CONCLUSION: In the general population, the cesarean delivery rate for the second twin after vaginal delivery of the first twin is approximately 9.5%. With the presence of breech and other malpresentations, the need for emergent cesarean delivery of the second twin after vaginal delivery of the first twin is increased by 4-fold.

LEVEL OF EVIDENCE: II-2






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