Higher Maternal Morbidity With Trial of Labor for Twins vs. Elective C-Section
By Anne Harding; January 17, 2017
According to new research women who are pregnant with twins and have a trial of labor are at more risk of morbidity that those who are pregnant with twins and have a C-section.
Dr Sarah Rae Easter of Harvard Medical School Brigham Women’s Hospital explains, the trade off for a 74% vaginal birth is 4% more postpartum hemorrhage and 3% more obstetric laceration risk that are not present for a woman opting for cesarean delivery. Guidelines suggest a trial of labor if the presenting twin is vertex, but there is still little data about outcomes and mode of delivery. Guidelines for single pregnancies suggest avoiding a C-section for the first delivery, however twins represent a different clinical group in this sense.
In mothers of vertex-presenting twins, the researchers looked at 1,140 twin pregnancies from a seven-year period, with half attempting vaginal delivery and half having elective C-sections. According to their data the researchers comment that while their findings suggest a trend towards increased maternal morbidity in the trial of labor group, they do not view these findings as a deterrent to twin vaginal delivery. The researchers emphasize that the immediate risk of postpartum hemorrhage should be balanced with the benefits of vaginal delivery, and clinicians should consider the long-term effects of cesarean delivery on future pregnancies and adjust their practices accordingly. Dr Easter also adds that for women pregnant with twins who are considering trial of labor along with their physicians’ recommendations should be managed in a fully equipped hospital with an experienced team that can handle situations like breech presentations and postpartum hemorrhage.
Obstet Gynecol 2017.