Delivery of breech first twins: A multicenter retrospective study

Objective: To assess the risk of vaginal birth of breech first twins by Apg ar scores and mortality. Methods: We did a retrospective case-control analysis of data from 13 cente rs that allow vaginal birth for breech first twins. We used depressed 5-min ute Apgar scores and neonatal mortality as main outcome measures between va ginal (n = 239) and cesarean (n = 374) deliveries of pairs with breech firs t twins, stratified by parity, birth weights of first twins, and types of c esarean. The 95% power of our sample size (alpha =.05) was sensitive enough to detect differences of 5% of the overall sample and 25-30% of subgroups. Results: Vaginal birth was attempted in 61% of 613 pairs. There were signif icantly more depressed Apgar scores (P =.008, odds ratio [OR] 2.4, 95% conf idence interval [CII 1.2, 4.7) and neonatal deaths (P <.001, OR 9.5, 95% CI 4.0, 23.4) among vaginal births of pairs in whom first twins weighed less than 1500 g but not among the higher-birth-weight cohort (for depressed Apg ar scores: P = .76, OR 1.1, 95% CI 0.6, 2.1). Multiparity and elective cesa rean seemed to have little influence on outcome measures. Neonatal mortalit y was associated with extremely preterm twins. Conclusion: There was no evidence that vaginal birth is unsafe, in terms of depressed Apgar scores and neonatal mortality, for breech first twins that weighed at least 1500 g. (Obstet Gynecol 2000;95:37-42. (C) 2000 by The Am erican College of Obstetricians and Gynecologists.).