Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Neonatal mortality and morbidity in vertex–vertex second twins according to mode of delivery and birth weight

Journal of Perinatology volume 26, pages 3–10 (2006)Cite this article

Abstract

Objective:

To assess the risk of neonatal mortality and morbidity in vertex–vertex second twins according to mode of delivery and birth weight.

Study design:

Data from a historical cohort study based on a twin registry in the US (1995–1997) were used. Multivariate logistic regression was used to control for maternal age, race, marital status, cigarette smoking during pregnancy, parity, medical complications, gestational age, and other confounders.

Results:

A total of 86 041 vertex–vertex second twins were classified into two groups: second twins delivered by cesarean section after cesarean delivery of first twin (C–C) (43.0%), second twins whose co-twins delivered vaginally (V–X) (57.0%). In infants of birth weight ⩾2500 g group, the risks of noncongenital anomaly-related death (adjusted odds ratio (aOR): 4.64, 95% confidence interval (95% CI): 1.90, 13.92), low Apgar score (aOR: 2.39, 95% CI: 1.43, 4.14), and ventilation use (aOR: 1.31, 95% CI: 1.18, 1.47) were higher in the V–X group compared with the C–C group. No asphyxia-related neonatal deaths occurred in C–C group, whereas the incidence of this death was 0.04% in the V–X group.

Conclusion:

The risks of neonatal mortality and morbidity are increased in vertex–vertex second twins with birth weight ⩾2500 g whose co-twins delivered vaginally compared with second twins delivered by cesarean section after cesarean delivery of first twin.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Blondel B, Kaminski M . Trends in the occurrence, determinants, and consequences of multiple births. Semin Perinatol 2002; 26: 239–249.

    Article  Google Scholar 

  2. Power WP, Wampler NS . Further defining the risks confronting twins. Am J Obstet Gynecol 1996; 175: 1522–1528.

    Article  Google Scholar 

  3. Rydhstroem H . Should all twins be delivered by caesarean section? A preliminary report. Twin Res 2001; 4: 156–158.

    Article  CAS  Google Scholar 

  4. Smith GC, Pell JP, Dobbie R . Birth order, gestational age, and risk of delivery related perinatal death in twins: retrospective cohort study. BMJ 2002; 325: 1004–1009.

    Article  Google Scholar 

  5. Wen SW, Fung Kee Fung K, Oppenheimer L, Demissie K, Yang Q, Walker M . Neonatal mortality in second twin according to cause of death, gestational age, and mode of delivery. Am J Obstet Gynocol 2004; 191: 778–783.

    Article  Google Scholar 

  6. Wen SW, Fung Kee Fung K, Oppenheimer L, Demissie K, Yang Q, Walker M . Neonatal morbidity in second twin according to gestational age at birth and mode of delivery. Am J Obstet Gynocol 2004; 191: 773–777.

    Article  Google Scholar 

  7. Wen SW, Fung Kee Fung K, Oppenheimer L, Demissie K, Yang Q, Walker M . Occurrence and clinical predictors of emergent cesarean delivery for second twin. Obstet Gynecol 2004; 103: 413–419.

    Article  Google Scholar 

  8. Chervenak FA, Johnson RE, Berkowitz RL, Hobbins JC . Intrapartum external version of the second twin. Obstet Gynecol 1983; 62: 160–165.

    CAS  PubMed  Google Scholar 

  9. Crawford JS . A prospective study of 200 consecutive twin deliveries. Anaesthesia 1987; 42: 33–43.

    Article  CAS  Google Scholar 

  10. Divon MY, Marin MJ, Pollack RN, Katz NT, Henderson C, Aboulafia Y et al. Twin gestation: fetal presentation as a function of gestational age. Am J Obstet Gynecol 1993; 168: 1500–1502.

    Article  CAS  Google Scholar 

  11. Kelsick F, Minkoff H . Management of the breech second twin. Am J Obstet Gynecol 1982; 144: 783–786.

    Article  CAS  Google Scholar 

  12. Thompson SA, Lyons TJ, Makowski EL . Outcomes of twin gestation at the University of Colorado Health Science centre. J Reproduct Med 1987; 32: 328–329.

    CAS  Google Scholar 

  13. Laros RK, Dattel BJ . Management of twin pregnancy; the vaginal route is still safe. Am J Obstet Gynecol 1998; 158: 1330–1338.

    Article  Google Scholar 

  14. Piekarski P, Czajkowski K, Maj K, Milewczyk P . Neonatal outcome depending on the mode of delivery and fetal presentation in twin gestation (abstract). Ginekol Pol 1997; 68: 187–192.

    CAS  PubMed  Google Scholar 

  15. Boggess KA, Chisholm CA . Delivery of the nonvertex second twin: a review of the literature. Obstet Gynecol Surv 1997; 52: 728–735.

    Article  CAS  Google Scholar 

  16. Blickstein I . Cesarean section for all twins? J Perinat Med 2000; 28: 169–174.

    Article  CAS  Google Scholar 

  17. Anonymous. Special problems of multiple gestations. Int J Gynaecol Obstet 1999; 64: 323–333.

  18. Barrett J, Bocking A . The SOGC consensus statement on management of twin pregnancies (Part I). J SOGC 2000; 91: 519–532.

    Google Scholar 

  19. National Center for Health Statistics. 1995–1997 Matched Multiple Birth Data Set. NCHS CD-ROM Series 21, No. 12. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention: Hyattsville, Maryland; 2000.

  20. Cole S, Hartford RB, Bersjo P, McCarthy B . International collaborative effort (ICE) in birth weight, plurality, perinatal and infant mortality. Acta Obstet Gynecol Scand 1989; 68: 113–117.

    Article  CAS  Google Scholar 

  21. Yang Q, Wen SW, Chen Y, Krewski D, Fung Kee Fung K, Walker M . Neonatal mortality and morbidity in vertex–nonvertex second twins according to mode of delivery and birth weight. Am J Obstet Gynecol 2005; 192: 840–847.

    Article  Google Scholar 

  22. Sullivan CA, Harkins D, Seago DP, Roberts WE, Morrison JC . Cesarean delivery for the second twin in the vertex–vertex presentation: operative indications and predictability. South Med J 1998; 91: 155–158.

    Article  CAS  Google Scholar 

  23. Huston P, Naylor CD . Health services research: reporting on studies using secondary data sources. Can Med Assoc J 1996; 155: 1697–1702.

    CAS  Google Scholar 

  24. Millimet D . What is the difference between ‘endogeneity’ and ‘sample selection bias’? Frequently Asked Questions (FAQ) for STATA, http://www.stata.com/support/faqs/stat/bias.html.

  25. Wen SW, Joseph KS, Kramer MS, Demissie K, Oppenheimer L, Liston R, et al., For the Fetal and Infant Mortality Study Group. Canadian Perinatal Surveillance System. Recent secular trends in fetal and infant outcomes among post-term pregnancies. Chron Dis Can 2001; 22: 1–5.

    CAS  Google Scholar 

  26. Greig P, Veille J, Morgan T, Henderson L . The effect of presentation and mode of delivery on neonatal outcome in the second twin. Am J Obstet Gynecol 1992; 167: 901–906.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, OMNI Research Group, Faculty of Medicine, University of Ottawa, Ottawa, Canada

    Q Yang, S W Wen, K Fung Kee Fung & M Walker

  2. Ottawa Health Research Institute, Ottawa, Canada

    Q Yang, S W Wen & M Walker

  3. McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada

    Q Yang & D Krewski

  4. Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada

    S W Wen, Y Chen & D Krewski

Authors
  1. Q Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S W Wen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Y Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D Krewski
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K Fung Kee Fung
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M Walker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Q Yang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yang, Q., Wen, S., Chen, Y. et al. Neonatal mortality and morbidity in vertex–vertex second twins according to mode of delivery and birth weight. J Perinatol 26, 3–10 (2006). https://doi.org/10.1038/sj.jp.7211408

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jp.7211408

Keywords

This article is cited by

Search

Advanced search

Quick links