Cesarean Delivery May Prevent Perinatal Twin Death

Laurie Barclay, MD

November 01, 2002

Nov. 1, 2002 — Second twins born of vaginal delivery are at higher risk of death than first-born twins from complications during labor and delivery, according to the results of a retrospective cohort study in the Nov. 2 issue of the British Medical Journal.

"Since the excess of deaths of second twins at term seems to be attributable to labor,...planned caesarean delivery may be protective against perinatal death among twins," write Gordon C.S. Smith, from the Greater Glasgow Health Board in Scotland, and colleagues.

Records review and analysis of the births of 2,436 twin pairs born in Scotland between 1992 and 1997 revealed significantly increased risks of death during labor and neonatal death among second twins born at or after 36 weeks' gestation. None of the first twins but nine of the second twins died ( P=.004). Anoxia during birth caused seven of these deaths, including five deaths related to mechanical problems following vaginal delivery of the first twin. There were no perinatal deaths among 454 second twins delivered at term by planned caesarean section.

The absolute risk of death for second twins born at term was approximately 1 in 270 for all causes, 1 in 350 for death due to anoxia during the birth, and 1 in 500 for anoxic death due to mechanical problems. These absolute risks are high compared with those for singleton term births in Scotland during the same period.

"We propose that women with twins should be counseled about the risk to the second twin and the theoretical possibility of a protective effect of planned caesarean section when considering mode of delivery at term," the authors write.

BMJ. 2002;325:1004-1006

Reviewed by Gary D. Vogin, MD

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