EVIDENCE THAT WOMEN WITH A HISTORY OF CESAREAN-SECTION CAN DELIVER TWINS SAFELY

Objective. To determine whether a trial of labor is safe in twin pregn ancies after one previous cesarean section. Study design. Retrospectiv e analysis of all cases of multiple pregnancies after cesarean section during the years 1970-1993, including twin gestations after one cesar ean section. Results. Forty-six cases of multiple gestations were foun d, 36 of which were eligible for the study presented herein. Fifteen w omen (41.7%) were denied trial of labor. Twenty-one women (58.3%) were allowed trial of labor, 17 (80.9%) of whom were delivered vaginally a nd four (19.1%) by a repeated cesarean section. The group of trial of labor was compared to the group of elective cesarean section. Hospital ization period was 4.4 +/- 1.9 days and 8.0 +/- 2.6 days in the trial of labor group and elective cesarean section group, respectively (p < 0.01). Blood transfusions required were 9.5% and 26.6% in both groups, respectively (NS). Puerperial infections were 9.5% in the trial of la bor group, compared to 46.6% in the elective cesarean section group (N S). No scar dehiscence occurred in either groups. There were no statis tically significant differences in age, parity, gestational age at del ivery, mean newborn weight, Apgar score at one and five minutes, Neona tal Intensive Care Unit admission and mean Neonatal Intensive Care Uni t stay. Conclusions. Vaginal delivery in twin gestation after one prev ious cesarean section may be considered in appropriate cases. A large multicentral randomized prospective study may further confirm this con clusion.