The influence of breach position of the second twinon perinatal outcomes in vaginal births of bichorial - biamniotic twins after 33rd week of gravidity

Authors: V. Ťápalová;  L. Hruban;  P. Janků;  P. Ventruba;  I. Vlašínová;  Z. Hodická;  I. Rejdová
Authors‘ workplace: Gynekologicko-porodnická klinika LF MU a FN, Brno, přednosta prof. MUDr. P. Ventruba, DrSc., MBA
Published in: Ceska Gynekol 2014; 79(5): 350-355


The objective is to evaluate whether a breach presentation of the second twin has an influence on the perinatal results in vaginal births of bichorial-biamniotic twins after 33rd week of pregnancy.

Retrospective analysis.

Department of Obstetrics and Gynecology, Masaryk University and University Hospital Brno.

Sample and methods:
The current study is a retrospective analysis of 695 vaginal births of bichorial-biamniotic twins after 33rd week of pregnancy. All births were conducted at the Department of Obstetrics and Gynecology, Masaryk University and University Hospital Brno during the span of 2004–2013. The sample was divided into2 groups. Group A consisted of 550 births of both twins in vertex presentation, group B consisted of 145 births in which the second twin happened to be in the breach presentation. The factors that have been evaluated include the percentage of births finished vaginally, perinatal results (pH a. umbilicalis below 7.0 and Apgar score in the 5th minute below 5) and early neonatal mortality and morbidity. Data from both groups have been compared with the use of Fisher‘s exact test.

For the group A, 81.3% of births were finished vaginally, as opposed to 85.5% in group B. Acute Caesarean sections conducted on the second twin consisted 4% (22 cases) in group A and 3.4% (5 cases) in group B. No significant difference has been found between the two groups in both perinatal results (p = 0.6 for pH from a. umbilicalis below 7.0 and p = 0.7 for Apgar score in the 5th minute below 5; both two-tailed) and in the frequency of early neonatal mortality and morbidity. In total,5 neonatal deaths have occured in 28 days after birth, out of which 2 have occured in group A and 3 in group B.

It was concluded that breach presentation of the second twin does not influence perinatal results in vaginal births of bichorial-biamniotic twins.

bichorial-biamniotic twins, vaginal birth, breach presentation, perinatal mortality, perinatal morbidity


1. Antsaklis, A., Malamas, MF., Sindos, M. Trends in twin pregnancies and mode of delivery during the last 30 years: inconsistency between guidelines and clinical practice. J Perinat Med, 2013, 41(4), p. 355–364.

2. Arabin, B., Kyvernitakis, I. Vaginal delivery of the second nonvertex twin avoiding a poor outcome when the presenting part is not engaged. Obstet Gynecol, 2011, 118, p. 950–954.

3. Atis, A., Aydin, Y., Donmez, M., et al. Apgar scores in assessing morbidity of the second neonate of cephalic/noncephalic twins in different delivery modes. J Obstet Gynaecol, 2011, 31, p. 43–47.

4. Barrett, J., Bocking, A., et al. Management of twin pregnan-cies. The SOGC consensus statement. J SOGC, 2000, 91, p. 1–11.

5. Bisschop Steins, CHN., Vogelvang, T., May, AM, Schuite-maker, E. Mode of delivery in non-cephalic presenting twins:a systematic review. Arch Gynecol Obstet, 2012, 286, p. 237–247.

6. Blickstein, I. Cesarean section for all twins? J Perinat Med, 2000, 28, p. 169–174.

7. Blondel, B., Macfarlane, A., Gissler, M., et al. Preterm birth and multiple pregnancy in European countries participating in the PERISTAT project. BJOG, 2006, 113, p. 528–535

8. Carroll, MA., Yeomans, ER. Vaginal delivery of twins. Clin Obstet Gynecol, 2006, 49, p. 154–166.

9. Cruikshank, DP. Intrapartum management of twin gestations. Obstet Gynecol, 2007, 109, p. 1167–1176.

10. ČSÚ. Demografická ročenka České republiky 2002–2012.

11. Fishman, A., Grubb, DK., Kovacs, BW. Vaginal delivery of the nonvertex second twin. Am J Obstet Gynecol, 1993, 168, p. 861–864.

12. Ganchimeg, T., Morisaki, N.,Vogel, JP., et al. Mode and timing of twin delivery and perinatal outcomes in low- and middle-income countries: a secondary analysis of the WHO multicountry survey on maternal and newborn health. BJOG, 2014, 121, Suppl., p. 89–100.

13. Hogle, KL., Hutton, EK., McBrien, KA., et al. Cesarean delivery for twins: a systematic review and meta-analysis. Am J Obstet Gynecol, 2003, 188, p. 220–227.

14. Hruban, L., Janků, P., Ventruba, P., et al. Vedení porodu po předchozím císařském řezu, analýza výsledků z let 2007–2010. Čes Gynek, 2012, 77, č. 2, s. 127–132.

15. Huser, M., Belkov, IA., Janku, P., et al. Pregnancy and delivery following midurethral sling surgery for stress urinary incontinence. Int J Gynecol Obstet, 2012, 119, p. 117–120.

16. Chervenak, FA., Johnson, RE., Berkowitz, RL., et al. Is routine cesarean section necessary for vertexbreech and vertex-transverse twin gestations? Am J Obstet Gynecol, 1984, 148, p. 1–5.

17. Martikainen, H., Tiitinen, A., Tomas, C., et al. One versus two embryo transfer after IVF and ICSI: a randomized study. Hum Reprod, 2001, 16, p. 1900–1903.

18. Martin, JA., Hamilton, BE., Osterman, MJK. Three decades of twin births in the United States, 1980–2009. Hyattsville, MD: National Center for Health Statistics; 2012.

19. Multiple gestation: complicated twin, triplet, and high-order multifetal pregnancy. ACOG Committee Opinion No. 382, American College of Obstetricians and Gynecologists. Obstet Gynecol, 104, 4, p. 869–883.

20. Peaceman, AM., Kuo, L., Feinglass, J. Infant morbidity and mortality associated with vaginal delivery in twin gestations. Am J Obstet Gynecol, 2009, 200, p. 462–466.

21. Rossi, AC., Mullin, PM., Chmaitb, RH. Neonatal outcomes of twins according to birth order, presentation and mode of delivery: a systematic review and meta-analysis. BJOG, 2011, 118, p. 523–532.

22. Roztočil, A., Hajek, Z. Vedení porodu vícečetného těhotenství. Čes Gynek, 2013, 78, p. 22–24.

23. Schaaf, JM., Mol, Abu-Hanna, A., et al. Trends in preterm birth: singleton and multiple pregnancies in the Netherlands, 2000–2007. BJOG, 2011, 118, p. 1196–1204.

24. Silver, RM., Landon, MB., Rouse, DJ., et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol, 2006, 107, p. 1226–1232.

25. Vayssière, C., Benoist, G., Blondel, B., et al. Twin pregnancies: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol, 2011, 156(1), p. 7–12.

26. Velebil, P. Epidemiologie císařského řezu. Moderní gynekologie a porodnictví, 2008, 17, p. 12–16.

27. Ventruba, P., Žáková, J., Trávník, P., et al. Aktuální otázky asistované reprodukce v České republice. Čes Gynek, 2013, 78, s. 392–398.

28. Vogel, JP., et al. BMC Pregnancy and Childbirth, 2014, p. 2–14.

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