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Mode Of Delivery Of Preterm Twins
Author(s) -
Doyle L. W.,
Hughes C. D.,
Guaran R.L.,
Quinn M. A.,
Kitchen W. H.
Publication year - 1988
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1988.tb01605.x
Subject(s) - caesarean section , obstetrics , medicine , vaginal delivery , respiratory distress , gestational age , caesarean delivery , pregnancy , surgery , genetics , biology
EDITORIAL COMMENT: This paper concludes that the vaginal route is appropriate, in terms of perinatal mortality and immediate morbidity, for the delivery of approximately 80% of twins born before 33 weeks' gestation. The trend towards Caesarean section in multiple pregnancy should be scrutinized as for singleton pregnancies. Falling perinatal mortality rates associated with increased Caesarean section rates do not prove a cause and effect relationship. The following statistics for multiple pregnancy at a State and Hospital level are quoted for perspective (tables 1A and IB). At the Mercy Maternity Hospital the Caesarean section rate for multiple pregnancy (triplets and quadruplets included) has quadrupled to 32% in 16 years, during which time the overall Caesarean section rate increased from 9 to 16%; this was associated with a modest (25%) improvement in the perinatal mortality rate. Comparable figures for the State of Victoria are not available, but from 1976 ‐ 1985, the total perinatal mortality rate has fallen approximately 30%, and multiple pregnancy continues to account for about 10% of perinatal deaths. In 1985, in Victoria, 2.3% of all infants (1,422 of 61,176) were bom from multiple pregnancies and they accounted for 8.2% (61 of 741) of all perinatal deaths in infants born with birth‐weight of 500g or above. Summary: At one high‐risk perinatal centre over a 9‐year period, 83.1% (103/124) sets of liveborn twins with gestational ages less than 33 weeks were delivered vaginally. Mortality in vaginal births was 26.7% (55/206), almost double that of Caesarean births of 14.3% (6/42), a non‐significant difference. When gestational age discrepancies were corrected, however, the trend favouring survival of Caesarean births disappeared. Furthermore, there were no significant associations between mode of delivery and the condition of the infants at birth, or the presence of respiratory distress in the nursery. Because Caesarean section carries substantial risks for the mother our practice of predominantly vaginal deliveries for preterm twins should continue.