Perinatal Outcome of Vaginally Delivered Twin Gestations With a Larger Twin B

• Published in: Journal of Perinatology Vol. 23; no. 5; pp. 409 - 413
• Main Authors: Usta, Ihab M, Nassar, Anwar H, Abu Musa, Antoine A, Awwad, Johnny T, Yunis, Khalid A, Seoud, Muhieddine A-F
• Format: Journal Article
• Language: English
• Published: United States Nature Publishing Group 01-07-2003
• Subjects: Adult; Apgar score; Birth Order; Birth size; Birth Weight; Breech delivery; Child Development - physiology; Childbirth & labor; Cohort Studies; Delivery, Obstetric - methods; Demographics; Demography; Female; Fetofetal transfusion; Follow-Up Studies; Gestational Age; Hemorrhage; Humans; Hyperbilirubinemia; Infant, Newborn; Labor Presentation; Methods; Neonates; Nurseries; Obstetric Labor Complications - diagnosis; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Prenatal diagnosis; Probability; Retrospective Studies; Reviews; Seizures; Sepsis; Twins
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/sj.jp.7210935

To study the perinatal outcome of vaginally delivered twins when twin B is more than 250 g larger than twin A.
Maternal and neonatal charts of live-born, nonanomalous twins, >25 weeks' gestation and vaginally delivered over a period of 17 years were reviewed. The results of this review were distributed among two groups: (1). those with twin B more than 250 g larger than twin A (DeltaBW>250) and (2). those where the difference was <250 g (DeltaBW<250). For vaginally delivered twin gestations, the perinatal outcome of twin B in the group DeltaBW>250 was compared to that of its co-twin, and to that of twin B in the group DeltaBW<250.
Of the 679 twin gestations reviewed, 138 (20.6%) were in the group DeltaBW>250, of whom 73 (52.9%) delivered vaginally despite malpresentation in 39.7%. The vaginally delivered twin pregnancies in the groups DeltaBW>250 (n=73) and DeltaBW<250 (n=303) had similar demographics, parity, presentation, gestational age at delivery, and duration of the first stage of labor. Discordant twins were more frequent in the group DeltaBW>250 (26.0 versus 9.5%, p=0.001). Twin B in the group DeltaBW<250 was smaller, with higher incidence of growth restriction, low 5 min Apgar score, and hyperbilirubinemia compared to twin B in the group DeltaBW>250. There was no difference in the incidence of intraventricular hemorrhage, seizures, sepsis, neonatal death, and median nursery stay. Except for a lower median Apgar score at 1 min in twin B and a longer median nursery stay in twin A, twins A and B in the group DeltaBW>250 were similar regarding all other neonatal outcome variables.
When twin B is more than 250 g larger than A, and both are delivered vaginally, the perinatal outcome is similar to its co-twin as well as to that of twin B of all other vaginally delivered twins. That twin B is larger than A is not itself a contraindication to attempted vaginal delivery.