Delivery of breech first twins: a multicenter retrospective study

Objective: To assess the risk of vaginal birth of breech first twins by Apgar scores and mortality. Methods: We did a retrospective case-control analysis of data from 13 centers that allow vaginal birth for breech first twins. We used depressed 5-minute Apgar scores and neonatal mortality as main outcome measures between vaginal ( n = 239) and cesarean ( n = 374) deliveries of pairs with breech first twins, stratified by parity, birth weights of first twins, and types of cesarean. The 95% power of our sample size (α = .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 significantly more depressed Apgar scores ( P = .008, odds ratio [OR] 2.4, 95% confidence interval [CI] 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 Apgar scores: P = .76, OR 1.1, 95% CI 0.6, 2.1). Multiparity and elective cesarean seemed to have little influence on outcome measures. Neonatal mortality 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.