Intrapartum management of twin pregnancies: are uncomplicated monochorionic pregnancies more at risk of complications than dichorionic pregnancies?

ObjectiveTo analyze mode of delivery and neonatal morbidity according to chorionicity in a hospital birth center with a policy of vaginal delivery for twins. Study designRetrospective analysis over a 13-year period. SettingDepartment of Obstetrics, University Hospital, Lille, France. PopulationIn all, 1009 twin pregnancies were included, divided into 171 uncomplicated monochorionic pregnancies (17%) and 838 dichorionic pregnancies (83%). MethodsWe compared the monochorionic and the dichorionic populations. Main outcome measuresRate of cesarean section and neonatal outcome (umbilical artery pH, Apgar score and neonatal complications). ResultsThe rate of cesarean sections was 45.7% with no difference found based on chorionicity. The reasons for elective cesarean section were mainly noncephalic presentation, which was more frequent in dichorionic than in monochorionic (48.8% vs. 37.2%, p=0.025) pregnancies. Birthweight was lower in monochorionic twins (2249469g vs. 2329 +/- 478g, p=0.045). The rate of umbilical artery cord blood values with a pH<7.10 was similar in monochorionic and dichorionic pregnancies. There was no difference in neonatal complications between the two groups. ConclusionMonochorionic and dichorionic twin pregnancies had similar delivery outcomes. The neonatal outcome for twin 2 was not different between monochorionic and dichorionic pregnancies. Vaginal birth could be offered to women with twin pregnancies regardless of chorionicity.