Infant morbidity and mortality associated with vaginal delivery in twin gestations

Objective: To compare infant outcomes for twin gestations delivered vaginally with those with cesarean delivery by using a large national dataset containing birth certificate data. Study Design: Vertex/vertex presenting twins delivering at ≥ 30 weeks' gestation were separated by method of delivery and compared for neonatal morbidities and death in the first year of life. Similar comparisons were performed for vertex/nonvertex presenting twins. Results: For vertex/vertex presenting twins, vaginal delivery was not associated with an increase in composite morbidity or mortality compared with cesarean birth. For vertex/nonvertex presenting twins, vaginal delivery was associated with small increases in the incidences of 5-minute Apgar scores ≤ 3, ventilation for < 30 minutes, and birth injury but not seizures or infant death. When the birthweight of the second twin exceeded that of the first by 25% or more, excess morbidity with vaginal delivery was not seen. Conclusion: For both vertex/vertex and vertex/nonvertex presentations, morbidity and mortality are similar for vaginal and cesarean deliveries of twin gestations at or beyond 30 weeks' gestation.