[Vaginal birth after caesarean delivery in twin gestation: is trial of labor allowed?].

OBJECTIVE

To determine if a trial of labor in twin pregnancy with previous cesarean section is an acceptable alternative to systematic cesarean section.

PATIENTS AND METHODS

Based on a retrospective and comparative study from 1st January 1996 to 30th June 2003 in Maternite Jeanne-de-Flandre (Lille) and Pavillon Paul-Gelle (Roubaix), 35 trials of labor in twin pregnancies with previous cesarean section have been compared with 35 twin gestations attempting vaginal delivery without a prior cesarean. This comparative study has been led by sorting out the patients according to their gestational age, parity and maternity.

RESULTS

Twenty-seven women (77%) delivered vaginally and eight (23%) by elective caesarean section. Postpartum hemorrhage was more frequent for caesarean section (75%). No scare dehiscence or rupture occurred. There was not any haemostasis hysterectomy or embolisation related to postpartum haemorrhage. Neonatal outcome was similar in both groups.

DISCUSSION AND CONCLUSION

Twin trial of labor after a previous cesarean section seems to be a safe alternative to routine repeat cesarean delivery as maternal and fetal morbidity and mortality are safe.