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Delivery of Breech First Twins: A Multicenter Retrospective Study

From the Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot; Department of Pediatrics, Sheba Medical Center, Tel Hashomer; and Lis Maternity Center, Tel Aviv, Israel.

Address reprint requests to: Isaac Blickstein, MD, Department of Obstetrics and Gynecology Kaplan Medical Center, Rehovot, 76100, Israel E-mail: blick{at}netvision.net.il

Objective: To assess the risk of vaginal birth of breech first twins by Apgar scores and mortality.

Methods: We did a retrospective case-control analysis of data from 13 centers that allow vaginal birth for breech first twins. We used depressed 5-minute Apgar scores and neonatal mortality as main outcome measures between vaginal (n = 239) and cesarean (n = 374) deliveries of pairs with breech first twins, stratified by parity, birth weights of first twins, and types of cesarean. The 95% power of our sample size ( = .05) was sensitive enough to detect differences of 5% of the overall sample and 25–30% of subgroups.

Results: Vaginal birth was attempted in 61% of 613 pairs. There were significantly more depressed Apgar scores (P = .008, odds ratio [OR] 2.4, 95% confidence interval [CI] 1.2, 4.7) and neonatal deaths (P < .001, OR 9.5, 95% CI 4.0, 23.4) among vaginal births of pairs in whom first twins weighed less than 1500 g but not among the higher-birth-weight cohort (for depressed Apgar scores: P = .76, OR 1.1, 95% CI 0.6, 2.1). Multiparity and elective cesarean seemed to have little influence on outcome measures. Neonatal mortality was associated with extremely preterm twins.

Conclusion: There was no evidence that vaginal birth is unsafe, in terms of depressed Apgar scores and neonatal mortality, for breech first twins that weighed at least 1500 g.

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