OBJECTIVE:

To compare maternal and neonatal morbidity and mortality between trial of labor and planned caesarean section in twin pregnancies.

MATERIALS AND METHODS:

A retrospective cohort study in Donostia University Hospital during 2016 and 2017 including monochorial-biamniotic and bichorial biamniotic twin pregnancies >24+0 weeks of gestation. Gestations with antenatal death of one or both fetuses were excluded. Patients were classified into trial of labor group and planned cesarean section group. Primary outcomes were maternal and neonatal morbidity and mortality. Statistical analysis included χ2, Fisher´s exact test, Student´s T-test, Mann-Whitney U test and binary logistic regression models.

RESULTS:

Of 248 twin births, 173 (69.8%) were included in the attempted delivery group and 75 (30.2%) in the scheduled cesarean section group. No difference was found in maternal morbidity and mortality (OR 0.92; 95% CI 0.36-2.36). The attempted group had lower rates of admission to neonatal intensive care (first twin OR 0.27; 95% CI 0.13-0.56; second twin OR 0.29; 95% CI 0.14-0.58) and lower neonatal morbidity (first twin OR 0.37; 95% CI 0.19-0.71; second twin OR 0.42; 95% CI 0.22-0.79). The pH of the second twin’s cord blood was lower in the attempted delivery group (7.24 vs 7.28; p 0.017).

CONCLUSIONS:

Although second twins’ umbilical artery pH is lower in trial of labor group, neonatal morbidity is decreased. Therefore, trial of labor in selected cases is an adequate option that does not increase maternal and neonatal morbidity and mortality.