Risk factors for emergency cesarean delivery of the second twin after vaginal delivery of the first twin.

AIM: A case-control study of twins was performed to identify clinical predictions of emergency cesarean delivery in the second-born twin after vaginal delivery of the first twin.

METHODS

The obstetric records were reviewed of all twin vaginal deliveries at the Japanese Red Cross Katsushika Maternity Hospital from 2002 through 2007.

RESULTS

There were 206 vaginal deliveries of first twins at >or=33 weeks of gestation. Of these deliveries, nine women (4.4%) underwent an emergency cesarean for the delivery of the second twin. The incidence of cesarean delivery for the second twin was significantly greater in cases with a history of infertility therapy (odds ratio: 5.0, 95% confidence intervals: 1.2-22), gestational age at >or=39 weeks (24, 4.7-120), nonvertex presentation (6.2, 1.5-26), operative delivery of the first twin (6.1, 1.5-24) and intertwin delivery time interval >30 min (7.2, 1.7-30).

CONCLUSION

The most important risk factor of emergency cesarean delivery in the second twin was a gestational age of >or=39 weeks.