Is birth suite the safest place to deliver vaginal twins in a regional centre?: a retrospective review.

Abstract

Introduction: Approximately 1.5% of Australian pregnancies result in twins. Compared to singleton pregnancies, twin deliveries have higher rates of complications such as postpartum haemorrhage (PPH), and premature deliveries. However, there are no current national guidelines on the safety of delivering planned vaginal twins in a birth‐suite compared to an operating theatre in a regional hospital in Australia. Methods: This study retrospectively reviewed twin deliveries from 01/07/2013 to 31/12/2015 in a regional Level 5 hospital. Patients were identified by routinely collected data and included all women birthing twins from 24 weeks gestation. Private deliveries and those transferred in utero were excluded. Data regarding previous obstetrics history, antenatal care, and maternal and neonatal outcomes were extracted. Results: 33 twin deliveries were identified: 28 dichorionic diamniotic, 5 monochorionic diamniotic, and 21 preterm. 16 (48.4%) were planned vaginal deliveries, and 3 had emergency caesareans. 17 (51.5%) were planned caesarean sections, and 10 were emergencies. Out of 13 vaginal deliveries, 7 were in a birth suite, and 6 were in the operating theatre. Furthermore, 6 had PPH, and 8 Twin 1s and 3 Twin 2s needed instrumental delivery. 9 twins were admitted to a special care nursery and 1 was transferred to NICU. Women were more likely transferred to theatre if the twins were preterm or monochorionic. Further, women transferred to theatre had less instrumental deliveries for the second twin and less massive PPH. Discussion: This study illustrates that vaginal twin births in our centre had high rates of operative intervention for delivery of both twins and an increase in PPH. It appears from our data that it is reasonable and potentially safer to plan to deliver twins vaginally in theatre, rather than in a birth suite.