Factors associated with cesarean delivery of the second twin after vaginal delivery of the first twin: A case-control study

Objectives. - To identify risk factors for cesarean section of the second twin after vaginal delivery of the first twin. Methods. - Case-control study conducted between 2004 and 2018 in a tertiary center, CHU Toulouse. Cases were women with twin pregnancy who had vaginal delivery of the first twin and emergency cesarean of the second twin. Controls were women with twin pregnancy who delivered both twins vaginally. Deliveries before 24 weeks of gestation, birth weight of less than 500 grams, fetal death in utero, terminations of pregnancy and delayed delivery were excluded. The association between potential risk factors and cesarean delivery of the second twin was analyzed using multivariable logistic regression. Results. - Twenty-four patients who had vaginal delivery of the first twin and emergency cesarean of the second twin and 48 patients who delivered both twins vaginally were included. Neonatal morbidity was increased in the group of women who had an emergency cesarean of the second twin. In multivariable analysis, overweight (OR = 10.5 [95% CI: 1.78-62.03] for women with body mass index above 25 compared to women with body mass index below 25), weight gain during pregnancy (OR = 1.27 [95% CI: 1.01-1.48] for each kilogram) and preterm labor (OR = 4,43 [IC 95%:1,10-17,80]) were associated with significantly increased risk of cesarean section of the second twin. Conclusion. - Overweight and weight gain during pregnancy are associated with increased risk for cesarean section of the second twin. (C) 2022 Elsevier Masson SAS. All rights reserved.