Twin VBAC Not Associated With Increased Risk of Rupture


RENO, NEVADA — Attempting vaginal birth after cesarean section in twin deliveries may be no more risky than attempting VBAC in singleton pregnancies, according to a review of almost 25,000 deliveries.

The review found that women with twins who had a prior C-section were less likely to attempt a vaginal birth but that they had the same rate of VBAC failures and no higher rate of maternal complications, Alison Cahill, M.D., and her associates wrote in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

Women with twins should not be discouraged from making a VBAC attempt if that is their desire, according to data reported by Dr. Cahill of the University of Pennsylvania, Philadelphia, and her colleagues.

The study's subjects were patients from 17 different tertiary and community hospitals who were delivered between 1996 and 2000, and who were identified by coding in their pregnancy records as having had a previous cesarean section.

Of the 24,842 deliveries identified, 535 were twin pregnancies.

A total of 33% of the mothers with twins chose to attempt VBAC, compared with 55% of the women with singleton pregnancies.

The VBAC failed in 24% of the attempts of both groups.

Uterine rupture occurred in 2 of the twin pregnancies (1% of those who attempted VBAC), and 125 of the singleton pregnancies (also 1%).

In addition, 3% of the women with twins who attempted VBAC had either a uterine rupture, uterine artery laceration, bladder injury, and/or bowel injury.

That compared with 2% of the women with singletons, the researchers reported in the poster.

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