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Discussion Starter · #1 ·
If you wanna sticky, feel free. If you know of a study I forgot to add, feel free to add it. Forgive me (and also let me know so I can fix it) if any of these are repeated. My notes from when I was pregnant are a jumble.<br><br>
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Am J Obstet Gynecol. 2005 Sep ;193:1050-5 16157110 (P,S,E,B)<br>
Vaginal birth after cesarean (VBAC) attempt in twin pregnancies: is it safe?<br>
[My paper] Alison Cahill, David M Stamilio, Emmanuelle Paré, Jeffrey P Peipert, Erika J Stevens, Deborah B Nelson, George A Macones<br>
....RESULTS: Of 25,005 patients with at least 1 previous cesarean, there were 535 twin pregnancies and 24,307 singleton pregnancies. Compared with patients with singleton gestations, patients with twins were less likely to attempt a VBAC (adjusted odds ratio [AOR] 0.3, 95% CI 0.2-0.4), but no more likely to have a VBAC failure (AOR 1.1, 95% CI 0.8-1.6), a uterine rupture (AOR 1.2, 95% CI 0.3-4.6), or a major maternal morbidity (AOR 1.6, 95% CI 0.7-3.7). CONCLUSION: <b>Women with twin gestations are less likely to attempt a VBAC, but they are no more likely to fail a VBAC trial or experience a major morbid event compared with women with singleton gestations.</b><br><br>
[1] Evidence that women with a history of cesarean section can deliver twins safely.<br>
Acta Obstet Gynecol Scand 1997 Aug;76(7):663-6<br><br>
Odeh M, Tarazova L, Wolfson M, Oettinger M.<br><br>
Department of Obstetrics and Gynecology, Western Galille Medical Center, Nahariya, Israel.<br><br>
OBJECTIVE: To determine whether a trial of labor is safe in twin pregnancies after one previous cesarean section. STUDY DESIGN: Retrospective analysis of all cases of multiple pregnancies after cesarean section during the years 1970-1993, including twin gestations after one cesarean section.<br>
RESULTS: Forty-six cases of multiple gestations were found, 36 of which were eligible for the study presented herein. Fifteen women (41.7%) were denied trial of labor. Twenty-one women (58.3%) were allowed trial of labor, 17 (80.9%) of whom were delivered vaginally and four (19.1%) by a repeated cesarean section. The group of trial of labor was compared to the group of elective cesarean section. Hospitalization period was 4.4 +/- 1.9 days and 8.0 +/-2.6 days in the trial of labor group and elective cesarean section group, respectively (p<0.01). Blood transfusions required were 9.5% and 26.6% in both groups, respectively (NS). Puerperal infections were 9.5% in the trial of labor group, compared to 46.6% in the elective cesarean section group (NS). No scar dehiscence occurred in either groups. There were no statistically significant differences in age, parity, gestational age at delivery, mean newborn weight, Apgar score at one and five minutes, Neonatal Intensive Care Unit admission and mean Neonatal Intensive Care Unit stay.<br>
CONCLUSIONS: <b>Vaginal delivery in twin gestation after one previous cesarean section may be considered in appropriate cases. A large multicentral randomized prospective study may further confirm this conclusion.</b><br>
PMID: 9292641<br><br>
[2] Vaginal birth after cesarean delivery in the twin gestation.<br>
Obstet Gynecol 2000 Apr;95(4 Suppl 1):S65<br><br>
Myles TD, Miranda R.<br><br>
Texas Technical University Health Sciences Center, Amarillo, TX, USA<br><br>
Objective: The safety of vaginal birth after cesarean delivery (VBAC) in the singleton pregnancy has been known for many years. Despite this knowledge, most physicians feel the risk of VBAC in a twin pregnancy (TP) is too high despite the lack of documentation in the literature. We sought to determine if a VBAC for a TP carried greater risk than a singleton gestation.Methods: A retrospective study of all TP attempting VBAC from 1991 to 1999 were evaluated. The next three consecutive singleton pregnancies attempting VBAC also were evaluated. Comparisons were made for VBAC success and complications (blood loss, uterine rupture, hysterectomy, chorioamnionitis, blood transfusion, postpartum hemorrhage [PPH], and neonatal morbidity), and chi(2) test of association or Student's t tests were used where appropriate. Significance was set at P <0.05.Results: Nineteen TP met study criteria. There were 57 controls. Gestational ages were similar (TP 38.5; controls 38.7). The VBAC success rate was 84.2% for the TP and 75.4% for controls. The incidence of PPH was 5.3% for both groups. No PPH occurred in a TP with a successful VBAC. One uterine rupture occurred in the control group; none occurred in the TP group. No significant differences were found for any parameters tested, including 1- or 5-minute Apgar scores, venous or arterial pH, or neonatal intensive care unit admission.Conclusions: <b>The option of VBAC for TP appears to be safe and shares a similar likelihood of success as a singleton pregnancy. In view of the lack of increased complications, this option should be offered to patients with TP who are eligible for VBAC.</b><br>
PMID: 10729552<br><br>
[3] [Twin delivery after cesarean section: is a trial of labor warranted]?<br>
[Article in French]<br><br>
J Gynecol Obstet Biol Reprod (Paris) 1999 Dec;28(8):820-4<br><br>
Aboulfalah A, Abbassi H, el Karroumi M, Himmi A, el Mansouri A.<br><br>
Maternite Lalla Meryem, CHU Ibn Rochd, Casablanca, Maroc.<br><br>
OBJECTIVE: To determine whether a trial of labor in twin pregnancy is a valuable alternative to routine repeat cesarean section.<br>
MATERIAL AND METHODS: Based on retrospective analysis of 31 cases of twin gestation with previous cesarean section, we tried to assess the outcomes of 25 cases of trial of labor. The outcomes of trial of labor in twin pregnancy were compared to those of trial of labor in singleton pregnancy.<br>
RESULTS: The trial of labor was successful in 21 cases (84%). There was one case of scar dehiscence among the women who underwent a trial of labor, that occurred in the parturient with two previous cesarean sections after complete breech extraction. There were no significant differences in perinatal outcomes in any comparison of trial of labor versus no trial of labor. The outcomes of trial of labor in the twin pregnancy were similar to singleton pregnancy.<br>
CONCLUSIONS: <b>Routine repeat cesarean section in the twin pregnancy is not necessarily warranted; a controlled trial of labor in selected cases would be a valuable alternative.</b><br>
PMID: 10635485<br><br>
[4] Twin vaginal birth after cesarean.<br>
Conn Med 2000 Apr;64(4):205-8<br><br>
Wax JR, Philput C, Mather J, Steinfeld JD, Ingardia CJ.<br><br>
University of Connecticut School of Medicine, Department of Obstetrics and Gynecology, USA.<br><br>
OBJECTIVE: To determine both success rate and maternal-fetal outcome of vaginal birth after cesarean in twin gestations.<br>
METHODS: We identified all women from a single center attempting vaginal birth of twins after cesarean from 1988-98. Twin pairs were excluded for delivery < or = 25 weeks gestation, monoamnionicity, nonvertex twin A, or major anomaly or death of either twin. Cases were matched to the next three consecutive twin gestations attempting vaginal delivery without a prior cesarean. Variables matched were gestational age at delivery (+/- 1 week), presentations of both fetuses, labor onset (spontaneous or induced), and prior vaginal delivery (yes or no). The primary outcome was successful vaginal delivery of both fetuses. Secondary maternal outcomes included chorioamnionitis, hemorrhage requiring transfusion, hysterectomy, uterine rupture, and length of stay. Neonatal outcomes included one and five minute Apgars, NICU admission, and length of NICU stay.<br>
RESULTS: Twelve parturients were matched to 36 controls. There were no differences between the groups with respect to maternal demographics, intrapartum variables, fetal genders, birthweights, or chorionicity. Women with a prior cesarean (10/12) delivered both twins vaginally compared to 31/36 parturients without a prior cesarean (P = 1.0). There were no differences between cases and controls with respect to maternal morbidity (1/12 vs 4/36, P = 1.0), or postpartum stay (2.5 +/- 1.0 vs 2.5 +/- 2.3 days, P = .25). Neonatal outcomes were similar by birth order, except that second-born twins of cases had significantly longer NICU stays than controls (22.7 +/- 3.8 vs 10.4 +/- 7.8 days, P = .04).<br><br>
CONCLUSION: <b>Twin trial of labor after cesarean is associated with a high success rate of vaginal delivery but may be associated with a more lengthy NICU stay for the second twin.</b><br>
PMID: 10812766<br><br>
[5] Vaginal birth after cesarean delivery: can the trial of labor be extended?<br>
Source J Gynecol Obstet Biol Reprod (Paris), 27(4):425-9 1998 Jun<br><br>
Author Abbassi H ; Aboulfalah A ; el Karroumi M ; Bouhya S ; Bekkay M<br>
Address Maternit´e Lalla Meryem, CHU Ibn Rochd, Casablanca, Maroc.<br><br><br>
Abstract<br>
Based on a retrospective analysis of 1000 cases of scared uteri following cesarean section(s) (one cesarean, n = 857, 85.7%); two n = 129, 12.9%; three n = 14, 1.4%), we tried to answer two questions. Is trial of labor in case of low segment uterine-scar (excepting pelvic abnormalities, corporeal scar and more than two scars) free of risk for the mother and child? Can trial of labor be extended to cases of breech presentation, two previous cesarean sections, twin pregnancy and suspected macrosomia? In this series, the cesarean was indicated before labor in 138 cases (13.8%). Trial of labor was conducted in 862 cases (86.2%), and led to vaginal birth in 728 (84.5%). <b>Successful trial of labor was observed in 75% of twin pregnancies, in 100% of breech presentations and in 69.6% of macrosomic infants.</b> Uterine rupture occurred in 23 cases (2.7%), especially in cases with unknown corporeal scars (15 cases). No case of perinatal death related to uterine rupture was observed in this series.<br><br>
Language Fre<br>
Unique Identifier 98354619<br><br>
[7] Vaginal birth after cesarean section in twin gestation.<br>
****** DA, Mullin P, Hou D, Paul RH.<br>
Department of Obstetrics and Gynecology, Los Angeles County/University of Southern California Women's and Children's Hospital 90033, USA.<br>
Am J Obstet Gynecol 1996 Jul;175(1):194-8<br><br>
OBJECTIVE: We report a 10-year experience with vaginal birth after cesarean section in women with twins.<br>
STUDY DESIGN: Data were gathered from labor and delivery records and maternal and neonatal hospital charts. Women with a vertical uterine scar, a previous uterine rupture, an unrepaired dehiscence, or obstetric contraindications to labor were excluded from a trial of labor. Full-thickness uterine defects requiring intervention were classified as ruptures; all others were classified as dehiscences.<br><br>
RESULTS: Between Jan. 1, 1985, and Dec. 31, 1994, at Los Angeles County/University of Southern California Women's Hospital, 210 women with previous cesarean births were delivered of twins. One hundred eighteen (56%) underwent repeat cesarean delivery without a trial of labor. Ninety-two (44%) undertook a trial of labor with no uterine ruptures and no increase in maternal or perinatal morbidity or mortality.<br><br>
CONCLUSIONS: <b>In women with twins a trial of labor after a previous cesarean section is a safe and effective alternative to routine repeat cesarean delivery.</b><br>
PMID: 8694051 [PubMed - indexed for MEDLINE]<br><br>
Vaginal birth after cesarean delivery in twin gestations: a large, nationwide sample of deliveries.<br>
Ford AA, Bateman BT, Simpson LL.<br>
College of Physicians and Surgeons, Columbia University, New York, NY, USA.<br><br>
OBJECTIVE: The purpose of this study was to assess the maternal morbidity associated with attempted vaginal birth after cesarean (VBAC) in twin gestations using a large, nationwide sample of deliveries. STUDY DESIGN: Data for this study were obtained from an administrative dataset, the Nationwide Inpatient Sample, a representative sample of discharges from non-Federal hospitals, for the years 1993 to 2002. Patients admitted nonemergently for the delivery of twin gestations who had a history of previous cesarean delivery were selected. Patients that either delivered vaginally or who had discharge codes that indicated labor before cesarean delivery were defined as the trial of labor group, while patients who had a cesarean delivery without discharge codes that indicated labor were defined as the elective cesarean group. Various complications of delivery were analyzed for each group. RESULTS: We identified 4705 women who underwent an elective cesarean delivery and 1850 women who underwent a trial of labor. For women who had a trial of labor, 836 (45.2%) delivered vaginally. The rate of uterine rupture was higher in the trial of labor group than in the elective cesarean group (0.9% vs 0.1%, P < .001), and the rate of wound complications was lower (0.6% vs 1.3%, P < .02). The rates of other complications including hysterectomy, transfusion, major postpartum infection, thromboembolism, uterine dehiscence, and pelvic hematoma were not significantly different between the 2 groups. CONCLUSION: <b>Our study showed a significantly higher rate of uterine rupture in the trial of labor group that is similar to the rates reported for trial of labor after cesarean in singleton pregnancies.</b> <i>Christy's note: Note that they said not significantly higher rupture rate with twins than singletons, but that twin VBAC was associated with a higher rate of rupture compared to twin non-VBAC, just as singleton VBAC is associated with a higher rate of rupture compared to singleton non-VBAC.</i><br><br>
PMID: 17000246 [PubMed - indexed for MEDLINE]<br><br>
[Vaginal birth after caesarean delivery in twin gestation: is trial of labor allowed?]<br>
[Article in French]<br><br><br>
Coutty N, Deruelle P, Delahousse G, Le Goueff F, Subtil D.<br>
Clinique d'obstétrique, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, rue Eugène-Avinée, 59037 Lille, France.<br><br>
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: <b>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.</b><br>
PMID: 15501161 [PubMed - indexed for MEDLINE]<br><br>
J Obstet Gynaecol Can. 2003 Apr;25(4):294-8.Links<br>
Twin delivery after a previous caesarean: a twelve-year experience.<br>
Sansregret A, Bujold E, Gauthier RJ.<br>
Department of Obstetrics and Gynecology, Ste-Justine Hospital, University of Montreal, Montreal, QC, Canada.<br><br>
OBJECTIVES: To compare maternal and neonatal morbidities between trial of labour (TOL) and elective Caesarean section in women with twin pregnancies who have had a prior Caesarean. METHODS: An observational study was conducted of women with a prior Caesarean who delivered twins at 28 weeks gestation or greater in Ste-Justine Hospital between 1988 and 2001. Maternal and neonatal outcomes were compared between women who had a TOL (group 1) and those who had an elective Caesarean delivery (group 2). RESULTS: Twenty-six women and 52 fetuses were included in group 1 and compared to the 71 women and 142 fetuses in group 2. Maternal age, gestational age, and birth weight were comparable in both groups. In group 1, 22 (85%) out of 26 women delivered twin A vaginally and 19 (73%) delivered both vaginally. There was no significant difference in the umbilical artery cord pH, Apgar score, ventilatory support, and admission to the neonatal intensive care unit between the 2 groups. There was also no significant difference in the rate of postpartum maternal fever or decrease of serum hemoglobin between the 2 groups, but the median hospital stay was higher in the group with elective Caesarean (5.0 vs. 3.0 days, p <0.001). There were no uterine ruptures or other major complications in either group. CONCLUSION: <b>There were no significant differences in maternal and neonatal morbidity outcomes between births by trial of labour and by elective Caesarean, in twin pregnancies after a prior Caesarean section. A trial of labour is associated with a shorter hospital stay.</b><br>
PMID: 12679821 [PubMed - indexed for MEDLINE]<br><br>
J Obstet Gynaecol Can. 2003 Apr;25(4):289-92.Links<br>
Trial of labour compared to elective Caesarean in twin gestations with a previous Caesarean delivery.<br>
Delaney T, Young DC.<br>
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS, Canada.<br><br>
OBJECTIVE: To compare maternal and neonatal outcomes in twin gestations with a vertex presenting first twin undergoing either an elective repeat Caesarean section or a trial of labour subsequent to having had a Caesarean delivery in a prior pregnancy. METHODS: Maternal and newborn data from 1980 to 1999 in twin gestations, having 1 or more previous lower-segment Caesarean section(s) and a vertex presentation of the first twin, were analyzed from the Nova Scotia Atlee Perinatal Database. Categorical data were compared using chi-square or Fisher exact tests and continuous data by the Student t test. Logistic regression was used to control for covariates. RESULTS: Of the 121 women eligible for the data analysis, 38 chose to have a trial of labour, and 28 delivered vaginally with no uterine ruptures, scar dehiscences, maternal deaths, or increase in neonatal morbidity or mortality reported. Two Caesareans in the trial-of-labour group were for the delivery of the second twin. Women choosing elective Caesarean section had a higher incidence of infectious morbidity (p = 0.04). CONCLUSION: <b>In twin pregnancies with twin A presenting as a vertex, a cautious trial of labour may be an effective and safe alternative to elective repeat Caesarean section. Further research on a trial of labour after previous Caesarean section in twin gestations is warranted, as the studies published to date do not have sufficiently large numbers to detect adverse maternal and neonatal outcomes.</b><br><br>
PMID: 12679820 [PubMed - indexed for MEDLINE]<br><br>
J Obstet Gynaecol Can. 2003 Apr;25(4):275-86.Links<br>
Vaginal birth after Caesarean section: review of antenatal predictors of success.<br>
Brill Y, Windrim R.<br>
Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.<br><br>
OBJECTIVE: To determine antenatal factors that may predict successful vaginal birth after Caesarean (VBAC). DATA SOURCES: The MEDLINE database was searched for all English-language articles describing the impact of various factors on outcomes when VBAC is attempted. Articles reviewed included published abstracts, retrospective and prospective studies, and meta-analyses. CRITERIA FOR STUDY SELECTION: Studies were included if they reported both a control group of pregnant women without the factor under evaluation and a study group with this factor, both undergoing a trial of labour (TOL). Other criteria included accountability for all individuals enrolled at study outset, and vaginal delivery rates in both study and control groups stated or easily calculated. RESULTS: A nonrecurrent indication for previous Caesarean section (CS), such as breech presentation or fetal distress, is associated with a much higher successful VBAC rate than recurrent indications, such as cephalopelvic disproportion (CPD). Even with a history of CPD, two-thirds of women will have successful VBAC, though rates decrease with increasing numbers of prior CS. Prior vaginal deliveries are excellent prognostic indicators of successful VBAC, especially if the vaginal delivery follows the prior CS. A low vertical uterine incision does not seem to adversely affect VBAC success rates as compared to a low transverse incision. Maternal obesity and diabetes mellitus adversely affect VBAC outcomes. Fetal macrosomia does not appear to be a contraindication to VBAC, as success rates exceeding 50% are achieved and uterine rupture rates are not increased. Twin gestation does not preclude VBAC. Post-dates pregnancies may deliver successfully by VBAC in greater than two-thirds of cases. CONCLUSION: <b>There are few absolute contraindications to attempted VBAC. Attempted VBAC will be successful in the majority of attempted cases.</b><br><br>
PMID: 12679819 [PubMed - indexed for MEDLINE]<br><br>
J Matern Fetal Med. 2001 Jun;10(3):171-4. Links<br>
Vaginal birth of twins after a previous Cesarean section.<br>
Myles T.<br>
Department of Obstetrics and Gynecology, Texas Tech University Health Science Center, Amarillo 79106, USA. <a href="mailto:[email protected]">[email protected]</a><br><br>
OBJECTIVE: To determine whether a vaginal birth of twins after a Cesarean section carried greater risk than for a singleton gestation as well as determining whether there was a similar likelihood of successful vaginal birth. METHODS: A retrospective study was carried out of all twin pregnancies in which vaginal birth was attempted after a Cesarean section, in 1991-99. The next three consecutive singleton pregnancies in which vaginal birth was attempted after a Cesarean section were also evaluated. Comparisons were made for successful vaginal birth after Cesarean section complications (blood loss, uterine rupture or dehiscence, hysterectomy, chorioamnionitis and neonatal morbidity). Where appropriate, X2 tests of association or Student's t tests were used. Significance was set at p < 0.05. RESULTS: A total of 19 twin pregnancies met the study criteria. There were 57 controls. Gestational ages differed slightly (twin pregnancies, 36.3 weeks; controls, 39.3 weeks). The success rate of vaginal birth after Cesarean section was 84.2% for twin pregnancies and 75.4% for controls. The incidence of postpartum hemorrhage was 5.3% for both groups. One uterine rupture occurred in the control group; none occurred in the twin pregnancy group. One uterine dehiscence occurred in each group. No significant differences were found for any of the other parameters tested. CONCLUSION: <b>The option of vaginal birth of twins after Cesarean section appears to have a similar risk and shares a similar likelihood of success to those of a singleton pregnancy. In view of the lack of increased complications, this option can be offered to patients with twin pregnancies who are eligible for vaginal birth after Cesarean section.</b><br>
PMID: 11444785 [PubMed - indexed for MEDLINE<br><br><br>
Acta Obstet Gynecol Scand. 1997 Aug;76(7):663-6.Links<br>
Evidence that women with a history of cesarean section can deliver twins safely.<br>
Odeh M, Tarazova L, Wolfson M, Oettinger M.<br>
Department of Obstetrics and Gynecology, Western Galille Medical Center, Nahariya, Israel.<br><br>
OBJECTIVE: To determine whether a trial of labor is safe in twin pregnancies after one previous cesarean section. STUDY DESIGN: Retrospective analysis of all cases of multiple pregnancies after cesarean section during the years 1970-1993, including twin gestations after one cesarean section. RESULTS: Forty-six cases of multiple gestations were found, 36 of which were eligible for the study presented herein. Fifteen women (41.7%) were denied trial of labor. Twenty-one women (58.3%) were allowed trial of labor, 17 (80.9%) of whom were delivered vaginally and four (19.1%) by a repeated cesarean section. The group of trial of labor was compared to the group of elective cesarean section. Hospitalization period was 4.4 +/- 1.9 days and 8.0 +/- 2.6 days in the trial of labor group and elective cesarean section group, respectively (p<0.01). Blood transfusions required were 9.5% and 26.6% in both groups, respectively (NS). Puerperal infections were 9.5% in the trial of labor group, compared to 46.6% in the elective cesarean section group (NS). No scar dehiscence occurred in either groups. There were no statistically significant differences in age, parity, gestational age at delivery, mean newborn weight, Apgar score at one and five minutes, Neonatal Intensive Care Unit admission and mean Neonatal Intensive Care Unit stay. CONCLUSIONS: <b>Vaginal delivery in twin gestation after one previous cesarean section may be considered in appropriate cases. A large multicentral randomized prospective study may further confirm this conclusion.</b><br>
PMID: 9292641 [PubMed - indexed for MEDLINE<br><br>
Am J Obstet Gynecol. 1996 Jul;175(1):194-8. Links<br>
Vaginal birth after cesarean section in twin gestation.<br>
****** DA, Mullin P, Hou D, Paul RH.<br>
Department of Obstetrics and Gynecology, Los Angeles County/University of Southern California Women's and Children's Hospital 90033, USA.<br><br>
OBJECTIVE: We report a 10-year experience with vaginal birth after cesarean section in women with twins. STUDY DESIGN: Data were gathered from labor and delivery records and maternal and neonatal hospital charts. Women with a vertical uterine scar, a previous uterine rupture, an unrepaired dehiscence, or obstetric contraindications to labor were excluded from a trial of labor. Full-thickness uterine defects requiring intervention were classified as ruptures; all others were classified as dehiscences. RESULTS: Between Jan. 1, 1985, and Dec. 31, 1994, at Los Angeles County/University of Southern California Women's Hospital, 210 women with previous cesarean births were delivered of twins. One hundred eighteen (56%) underwent repeat cesarean delivery without a trial of labor. Ninety-two (44%) undertook a trial of labor with no uterine ruptures and no increase in maternal or perinatal morbidity or mortality. CONCLUSIONS: <b>In women with twins a trial of labor after a previous cesarean section is a safe and effective alternative to routine repeat cesarean delivery.</b><br>
PMID: 8694051 [PubMed - indexed for MEDLINE<br><br>
Hope that helps some of you, and I hope someone will sticky this. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile">
 

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Thanks for the informative post. I delivered my twins by vbac. My first child had been delivered by section for breech. Interestingly, my OB (a professor at a teaching hospital) actually recommended the vbac to me long before I had even thought about delivery. She said that in my case, she thought the vbac was less risky than the section, but I did not ask why (maybe because I was on lovenox). I am eternally grateful that she did so! Since then I have had two more vbacs, of singletons, and am hoping for one more vbac of a singleton this summer.<br><br>
Unfortunately, I rarely have read about others who have delivered twins by vbac - maybe only once or twice ever. Perhaps someone else who has done so will post here <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile">
 

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Well, I did. And I know of one other MDC-er who did that I actually met through ICAN and had the pleasure of meeting in person a few times while planning my birth. I have been contacted by a few MDC moms hoping to VBAC their twins recently mentioning that their OBs said there wasn't much in the research about the safety of VBAC with twins, and I knew I had this big file saved at home, so I thought I'd share for posterity. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile">
 

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I VBAC'd twins as well. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile"> In a car. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/lol.gif" style="border:0px solid;" title="lol">
 

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Does anyone know about VBACing a set of twins, when the first c/s was due to twins.<br>
I've been told that if I get pg with twins again I can not VBAC them. My chances for another set of twins is very high.
 

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<div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>JesiLynne</strong> <a href="/community/forum/post/13188972"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Does anyone know about VBACing a set of twins, when the first c/s was due to twins.<br>
I've been told that if I get pg with twins again I can not VBAC them. My chances for another set of twins is very high.</div>
</td>
</tr></table></div>
I was a gestational surrogate twice with TWO sets of twins. My first set was the c-section. My second set was the VBAC. This was never even brought up as an issue.
 
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