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Trial of labor compared with elective repeat cesarean section in twin gestations with previous cesarean delivery



Trial of labor compared with elective repeat cesarean section in twin gestations with previous cesarean delivery



American Journal of Obstetrics & Gynecology 184(1): S183



OBJECTIVE: To compare maternal and neonatal mortality and morbidity rates in twin gestations undergoing a trial of labor versus elective repeat cesarean section after prior cesarean delivery. STUDY DESIGN: Data were obtained from the Nova Scotia Atlee Perinatal Database from 1980 to 1999. The cohort consisted of mothers with twin gestations who had one or more previous lower-segment cesarean sections and a vertex presentation of the first twin. Categorical data were compared by use of chi2 or Fisher exact tests as appropriate. Continuous data were analyzed by the Student t test. RESULTS: One hundred twenty-one women with a twin gestation had one or more previous lower segment cesarean sections. Thirty-eight (31.4%) had a trial of labor, and 83 (68.6%) had an elective repeat cesarean section. Of the patients in the trial of labor group, 23.7% had a cesarean section, including 2 for the second twin. There were no uterine ruptures, incidents of scar dehiscence, or maternal deaths. Patients in the trial of labor group had a higher incidence of early postpartum hemorrhage (P = .01). Patients in the elective cesarean group had a higher incidence of infectious morbidity (P = .04). There was no increase in neonatal mortality or morbidity rates in those undergoing a trial of labor compared with elective repeat cesarean section. CONCLUSIONS: In our 19-year experience, trial of labor in twin gestations with a vertex presentation of the first twin and a history of cesarean section is associated with a high success rate of vaginal delivery without increased serious maternal morbidity or adverse neonatal outcomes. In this group of women a cautious trial of labor may be a safe alternative to elective repeat cesarean section.

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