Caesarean delivery of twins may prevent deaths

October 31, 2002

Second twins born at term are at higher risk of death due to complications during labour and delivery than first twins, but planned caesarean section may prevent such deaths, concludes a study in this week's BMJ.

Researchers analysed the births of over 4,500 twins born in Scotland between 1992 and 1997 and found significantly increased risks of death during labour and neonatal death among second twins born at term. No deaths were recorded among 454 second twins delivered at term by planned caesarean section.

The absolute risk of death for second twins born at term was approximately 1 in 270 for all causes, 1 in 350 for death due to lack of oxygen (anoxia) during the birth, and 1 in 500 for anoxic death due to mechanical problems. These absolute risks are high in comparison with similar data for singleton term births in Scotland over the same period, say the authors.

Since these deaths seem to be attributable to labour, planned caesarean delivery may offer some protection, suggest the authors.

"We propose that women with twins should be counselled about the risk to the second twin and the theoretical possibility of a protective effect of planned caesarean section when considering mode of delivery at term," they conclude.
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BMJ

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