Actual controversies in twin delivery

from the analysis of the case histories to a reasoned protocol

L. Valsecchi, A. Serafini, L. Maniscalsco, G. Frontino, A. Cardani, P. Cavoretto

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Aim. Twin pregnancy has to be considered a risk pregnancy. One of its most controversial aspects is delivery. There is no agreement on the following topics: gestational age at term (GA), mode of delivery, use of epidural analgesia or oxytocic acceleration, impact of chorionicity and amnionicity. The aim of this study was to develop a twin delivery management protocol. Methods. A retrospective study over a cohort population of 481 twin deliveries that occurred in the Department of Obstetrics of the San Raffaele Hospital of Milan (Italy) from 1996 to 2007 was conducted, and the results were compared with those present in literature. Results. Management of twin pregnancies that exceed the XXXVII week is controversial There is an inclination towards fixing bichorionic and monochorionic pregnancy terms at XXX-Vm and XXXV weeks respectively. In our case history, 73.8% of monochorionic and 15% of bichorionic pregnant women delivered after the XXV and XXXVm week respectively, without repercussions on the neonatal outcome. A longer gestational age appears to decrease the occurrence of lower Apgar scores and neonatal morbidity. This study, which exclusively considered twin pregnant women with both fetuses in cephalic presentation eligible for a vaginal delivery, did not find any significant differences in neonatal outcome among the types of deliveries. Moreover, the authors observed that the average maternal blood loss in cesarean section (CS) is significantly greater than that of vaginal deliveries. Conclusion. In consideration of its safety for mother and fetuses, vaginal delivery of two cephalic fetuses at XXXVUI and XXXV weeks for bichorionic and monochorionic pregan-cies respectively may be considered as a valid alternative to elective cesarean section.

Original languageEnglish
Pages (from-to)23-33
Number of pages11
JournalMinerva Ginecologica
Volume61
Issue number1
Publication statusPublished - Feb 2009

Fingerprint

Twin Pregnancy
Fetus
Cesarean Section
Gestational Age
Pregnant Women
Head
Mothers
Oxytocics
Pregnancy
Hospital Obstetrics and Gynecology Department
Epidural Analgesia
Apgar Score
Italy
Retrospective Studies
Morbidity
Safety
Population

Keywords

  • Analgesia
  • Apgar Score
  • Delivery, obstetrics
  • Epidural
  • Labor
  • Obstetrics
  • Pregnancy
  • Twins

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

Cite this

Valsecchi, L., Serafini, A., Maniscalsco, L., Frontino, G., Cardani, A., & Cavoretto, P. (2009). Actual controversies in twin delivery: from the analysis of the case histories to a reasoned protocol. Minerva Ginecologica, 61(1), 23-33.

Actual controversies in twin delivery : from the analysis of the case histories to a reasoned protocol. / Valsecchi, L.; Serafini, A.; Maniscalsco, L.; Frontino, G.; Cardani, A.; Cavoretto, P.

In: Minerva Ginecologica, Vol. 61, No. 1, 02.2009, p. 23-33.

Research output: Contribution to journalArticle

Valsecchi, L, Serafini, A, Maniscalsco, L, Frontino, G, Cardani, A & Cavoretto, P 2009, 'Actual controversies in twin delivery: from the analysis of the case histories to a reasoned protocol', Minerva Ginecologica, vol. 61, no. 1, pp. 23-33.
Valsecchi L, Serafini A, Maniscalsco L, Frontino G, Cardani A, Cavoretto P. Actual controversies in twin delivery: from the analysis of the case histories to a reasoned protocol. Minerva Ginecologica. 2009 Feb;61(1):23-33.
Valsecchi, L. ; Serafini, A. ; Maniscalsco, L. ; Frontino, G. ; Cardani, A. ; Cavoretto, P. / Actual controversies in twin delivery : from the analysis of the case histories to a reasoned protocol. In: Minerva Ginecologica. 2009 ; Vol. 61, No. 1. pp. 23-33.
@article{fb1c6468a4ba438abf28f95caee789cc,
title = "Actual controversies in twin delivery: from the analysis of the case histories to a reasoned protocol",
abstract = "Aim. Twin pregnancy has to be considered a risk pregnancy. One of its most controversial aspects is delivery. There is no agreement on the following topics: gestational age at term (GA), mode of delivery, use of epidural analgesia or oxytocic acceleration, impact of chorionicity and amnionicity. The aim of this study was to develop a twin delivery management protocol. Methods. A retrospective study over a cohort population of 481 twin deliveries that occurred in the Department of Obstetrics of the San Raffaele Hospital of Milan (Italy) from 1996 to 2007 was conducted, and the results were compared with those present in literature. Results. Management of twin pregnancies that exceed the XXXVII week is controversial There is an inclination towards fixing bichorionic and monochorionic pregnancy terms at XXX-Vm and XXXV weeks respectively. In our case history, 73.8{\%} of monochorionic and 15{\%} of bichorionic pregnant women delivered after the XXV and XXXVm week respectively, without repercussions on the neonatal outcome. A longer gestational age appears to decrease the occurrence of lower Apgar scores and neonatal morbidity. This study, which exclusively considered twin pregnant women with both fetuses in cephalic presentation eligible for a vaginal delivery, did not find any significant differences in neonatal outcome among the types of deliveries. Moreover, the authors observed that the average maternal blood loss in cesarean section (CS) is significantly greater than that of vaginal deliveries. Conclusion. In consideration of its safety for mother and fetuses, vaginal delivery of two cephalic fetuses at XXXVUI and XXXV weeks for bichorionic and monochorionic pregan-cies respectively may be considered as a valid alternative to elective cesarean section.",
keywords = "Analgesia, Apgar Score, Delivery, obstetrics, Epidural, Labor, Obstetrics, Pregnancy, Twins",
author = "L. Valsecchi and A. Serafini and L. Maniscalsco and G. Frontino and A. Cardani and P. Cavoretto",
year = "2009",
month = "2",
language = "English",
volume = "61",
pages = "23--33",
journal = "Minerva Ginecologica",
issn = "0026-4784",
publisher = "Edizioni Minerva Medica S.p.A.",
number = "1",

}

TY - JOUR

T1 - Actual controversies in twin delivery

T2 - from the analysis of the case histories to a reasoned protocol

AU - Valsecchi, L.

AU - Serafini, A.

AU - Maniscalsco, L.

AU - Frontino, G.

AU - Cardani, A.

AU - Cavoretto, P.

PY - 2009/2

Y1 - 2009/2

N2 - Aim. Twin pregnancy has to be considered a risk pregnancy. One of its most controversial aspects is delivery. There is no agreement on the following topics: gestational age at term (GA), mode of delivery, use of epidural analgesia or oxytocic acceleration, impact of chorionicity and amnionicity. The aim of this study was to develop a twin delivery management protocol. Methods. A retrospective study over a cohort population of 481 twin deliveries that occurred in the Department of Obstetrics of the San Raffaele Hospital of Milan (Italy) from 1996 to 2007 was conducted, and the results were compared with those present in literature. Results. Management of twin pregnancies that exceed the XXXVII week is controversial There is an inclination towards fixing bichorionic and monochorionic pregnancy terms at XXX-Vm and XXXV weeks respectively. In our case history, 73.8% of monochorionic and 15% of bichorionic pregnant women delivered after the XXV and XXXVm week respectively, without repercussions on the neonatal outcome. A longer gestational age appears to decrease the occurrence of lower Apgar scores and neonatal morbidity. This study, which exclusively considered twin pregnant women with both fetuses in cephalic presentation eligible for a vaginal delivery, did not find any significant differences in neonatal outcome among the types of deliveries. Moreover, the authors observed that the average maternal blood loss in cesarean section (CS) is significantly greater than that of vaginal deliveries. Conclusion. In consideration of its safety for mother and fetuses, vaginal delivery of two cephalic fetuses at XXXVUI and XXXV weeks for bichorionic and monochorionic pregan-cies respectively may be considered as a valid alternative to elective cesarean section.

AB - Aim. Twin pregnancy has to be considered a risk pregnancy. One of its most controversial aspects is delivery. There is no agreement on the following topics: gestational age at term (GA), mode of delivery, use of epidural analgesia or oxytocic acceleration, impact of chorionicity and amnionicity. The aim of this study was to develop a twin delivery management protocol. Methods. A retrospective study over a cohort population of 481 twin deliveries that occurred in the Department of Obstetrics of the San Raffaele Hospital of Milan (Italy) from 1996 to 2007 was conducted, and the results were compared with those present in literature. Results. Management of twin pregnancies that exceed the XXXVII week is controversial There is an inclination towards fixing bichorionic and monochorionic pregnancy terms at XXX-Vm and XXXV weeks respectively. In our case history, 73.8% of monochorionic and 15% of bichorionic pregnant women delivered after the XXV and XXXVm week respectively, without repercussions on the neonatal outcome. A longer gestational age appears to decrease the occurrence of lower Apgar scores and neonatal morbidity. This study, which exclusively considered twin pregnant women with both fetuses in cephalic presentation eligible for a vaginal delivery, did not find any significant differences in neonatal outcome among the types of deliveries. Moreover, the authors observed that the average maternal blood loss in cesarean section (CS) is significantly greater than that of vaginal deliveries. Conclusion. In consideration of its safety for mother and fetuses, vaginal delivery of two cephalic fetuses at XXXVUI and XXXV weeks for bichorionic and monochorionic pregan-cies respectively may be considered as a valid alternative to elective cesarean section.

KW - Analgesia

KW - Apgar Score

KW - Delivery, obstetrics

KW - Epidural

KW - Labor

KW - Obstetrics

KW - Pregnancy

KW - Twins

UR - http://www.scopus.com/inward/record.url?scp=67149137907&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=67149137907&partnerID=8YFLogxK

M3 - Article

VL - 61

SP - 23

EP - 33

JO - Minerva Ginecologica

JF - Minerva Ginecologica

SN - 0026-4784

IS - 1

ER -