VAGINAL BIRTH AFTER CESAREAN-SECTION IN TWIN GESTATION

OBJECTIVE: We report a 10-year experience with vaginal birth after ces arean section in women with twins. STUDY DESIGN: Data were gathered fr om labor and delivery records and maternal and neonatal hospital chart s. Women with a vertical uterine scar, a previous uterine rupture, an unrepaired dehiscence, or obstetric contraindications to labor were ex cluded from a trial of labor. Full-thickness uterine defects requiring intervention were classified as ruptures; all others were classified as dehiscences. RESULTS: Between Jan. 1, 1985, and Dec. 31, 1994, at L os Angeles County/University of Southern California Women's Hospital, 210 women with previous cesarean births were delivered of twins. One h undred eighteen (56%) underwent repeat cesarean delivery without a tri al of labor. Ninety-two (44%) undertook a trial of labor with no uteri ne ruptures and no increase in maternal or perinatal morbidity or mort ality. CONCLUSIONS: In women with twins a trial of labor after a previ ous cesarean section is a sale and effective alternative to routine re peal cesarean delivery.