Is it reasonable to propose vaginal delivery with twin pregnancies, when the first twin is in breech presentation? - Université de Lille Accéder directement au contenu
Article Dans Une Revue Journal of Gynecology Obstetrics and Human Reproduction Année : 2022

Is it reasonable to propose vaginal delivery with twin pregnancies, when the first twin is in breech presentation?

Résumé

Background Breech presentation of the first twin occurs in 20% of twin pregnancies. However, the impact of delivery mode on morbimortality in breech fetuses remains controversial in the literature generally, and has been infrequently studied in twin pregnancies specifically. The aim herein was to evaluate neonatal and maternal outcomes according to delivery mode when the first twin was in breech presentation, and to compare these results with those in the current literature. Material and methods This was a single-center, retrospective study in Lille, France, from January 2010 to December 2017, including twin pregnancies in which the first twin was in breech presentation and delivery was after 32 weeks of amenorrhea. Two groups were defined: planned vaginal delivery (PVD) and planned cesarean delivery (PCD). The primary outcome was neonatal morbidities, defined as a 5-minute Apgar score < 7, cord pH < 7.10 at birth, sepsis, and acute respiratory distress syndrome. Results Among the 184 patients included, 116 attempted a vaginal delivery (63%). Morbidity did not differ between PVD and PCD for the first twin (12/116 (10.3%) versus 7/68 (10.3%), respectively, p = 0.99), the second twin (18/116 (15.5%) versus 7/68 (10.3%), respectively, p = 0.31), or either twin (27/116 (23.2%) versus 11/68 (16.2%), respectively, p = 0.25). The rate of postpartum hemorrhage was significantly lower in the PVD group (PVD 36/116 (31%) versus PCD 41/68 (58.8%), p = 0.001). Conclusion PVD is a reasonable option when the first twin is in breech presentation with probably no higher neonatal mortality and morbidity and less risk of maternal severe postpartum hemorrhage.

Dates et versions

hal-04396782 , version 1 (16-01-2024)

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Citer

L. Ghesquière, J. Rouilles, Elodie Drumez, Veronique Debarge, Damien Subtil, et al.. Is it reasonable to propose vaginal delivery with twin pregnancies, when the first twin is in breech presentation?. Journal of Gynecology Obstetrics and Human Reproduction, 2022, Journal of Gynecology Obstetrics and Human Reproduction, pp.102377. ⟨10.1016/j.jogoh.2022.102377⟩. ⟨hal-04396782⟩

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