THE RELATIONSHIP OF INFECTION TO METHOD OF DELIVERY IN TWIN PREGNANCY

OBJECTIVE: Our purpose was to determine whether manipulation of the se cond twin increases the risk of postpartum infection. STUDY DESIGN: Me dical records of all twin deliveries between January 1991 and December 1994 were reviewed. The route of delivery (vaginal vs cesarean sectio n) was examined. The vaginal group was further divided into those deli vered in the vertex/vertex position (i.e., no uterine manipulation) ve rsus those delivered vertex/breech extraction (i.e., manipulation). Th e chi(2) and Student t test were used where appropriate. RESULTS: A to tal of 718 twins were identified, and maternal age, parity, gestationa l age at delivery (36 weeks), and birth weight (2278 gm) were similar among groups. The metritis rate was higher in the cesarean group (74/4 47 or 18%) than in the vaginal group (17/299 or 5.7%, p < 0.001). In c omparing the vaginal group delivered without uterine manipulation with the vaginal group delivered with manipulation (i.e., breech extractio n), there was no difference in the incidence of metritis (10/147 or 6. 8% vs 7/152 or 4.6%, not significant). The length of time between deli very of twin A and twin B did not affect the metritis rate. Neonatal o utcomes including sepsis, neonatal death, and length of hospitalizatio n were similar among groups (not significant). CONCLUSION: Uterine man ipulation of the second twin does not increase the risk of postpartum metritis or neonatal sepsis. In addition, the time interval between de livery of twins A and B has no effect on the rate of metritis. Althoug h the rate of endometritis has been reported to be higher with twins d elivered by cesarean section compared to singletons, the 18% rate of e ndometritis in twins delivered by cesarean section in this study is sl ightly lower than in our general population of cesarean deliveries.