Wednesday, January 18, 2017

Vaginal delivery in twins increases risk of maternal morbidity as compared to elective C-section.

A 7-year assembled retrospective cohort study of women with vertex presenting twin who underwent vaginal delivery have higher incidence of maternal morbidity as compared to women delivered by C-section.

The findings of this study was published on-line on January 9,2017 in Obstetrics andGynecology Journal.[1]

Guidelines suggest an attempt at vaginal birth if first twin is vertex with no uterine scar or other contraindication exits. Many  studies have compared neonatal mortality and morbidity but not much information is available on maternal morbidities based on route of delivery in twins.

 Dr. Sarah Rae Easter of Brigham and Women's Hospital and Harvard Medical School in Boston is the lead author of the study. She and her colleagues carried out the study from 2007-2014. Out of 2,272 twin pregnancies beyond 32 weeks of gestation, 1,140 (50%) met inclusion criteria of no uterine scar and no other contraindication for vaginal birth.  571 (50%) women chose to have elective cesarean delivery and 569 (50%) underwent a trial of labor to attempt vaginal birth. 

In the trial of vaginal birth group, 74% had an uneventful vaginal delivery, while others required operative assistance or breech extraction.

After adjusting for confounders, trial of labor group  had higher rate of maternal morbidity (12.3%) as compared to elective C-section group (9.1%). The rates of Postpartum hemorrhage were nearly twice in women having vaginal births.3% of women had major lacerations of genital tract.

An earlier RCT published in BJOG by Hutton EK et al did not show any difference in maternal morbidities in elective C-section vs Vaginal delivery group. [2]

Dr. Easter did not advice against trial of labor in twins, but wanted the clinicians to be more cautious while counselling the patients. She quoted. "Though our findings suggest a trend towards increased maternal morbidity in those who labor, we do not see this as a deterrent to twin vaginal delivery, we feel the immediate increased risk of postpartum hemorrhage should be balanced with the benefits of a vaginal birth. We hope clinicians will thoughtfully incorporate our findings into counseling while keeping in mind the known long-term consequences of Cesarean delivery and its impact on future pregnancies."

“Delivery in hospitals equipped to manage postpartum hemorrhage is of equal importance for mothers attempting vaginal birth of twins” she further added.

The authors concluded “In pragmatic terms, the tradeoff for a 74% chance of vaginal delivery is a 4% absolute increase in the rate of serious postpartum hemorrhage.”




[1] http://journals.lww.com/greenjournal/Abstract/publishahead/Association_of_Intended_Route_of_Delivery_and.98512.aspx
[2] https://www.ncbi.nlm.nih.gov/pubmed/26328526

12 comments:

  1. how I was cured from HERPES while this may sound discouraging and people may not belive that HERPES cure has be found,while i was once an HERPES positive i live with this disease for more than years now, i have been to so many places for help including hospitals wasted money and times hoping that i was going to get cure but nor was able, until God use someone to cure me from this disease (HERPES) true the help of a man called Dr OJOGUN with his herbal root herbs medicine. while i don’t have much to say but to give thanks and praise to God almighty who use Sir Dr OJOGUN to extend my life for what you have done for me DR, i will not stop thanking you because you put a smile on my face again,thanks once again if you are into similar problem or with any kind of diseases you can contact Sir Dr OJOGUN on his email {drojogunherbalmedicine@gmail.com} or call him or whatsapp on +2347059015454 and i will not stop thanking you DR OJOGUN for what you have done for me in my life, i will keep posting to the world for them to no that you are in existence , thanks for your audience and i hope you find help like i did for what he has done for me, if you are into similar problem like HERPES,CANCER,DIABETICS.do not waste time to contact him now his WhatsApp +2347059015454 and his email drojogunherbalmedicine@gmail.com

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    Replies
    1. God bless Dr.CHUKWU MADU for his wonderful work in my life, my name is Helen from USA, I was diagnosed of HERPES since 2016 and it has affected my life i was
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  5. I am so happy, i never believe i will be this happy again in life, I was working as an air-hoster ( cabby crew ) for 3years but early this year, i loose my job because of this deadly disease called Herpes virus (HSV), I never felt sick or have any symptom, till all workers were ask to bring their doctors report, that was how i got tested and i found out that am HSV positive that make me loose my job, because it was consider as an STD and is incurable disease, i was so depress was thinking of committing suicide, till i explain to a friend of mine, who always said to me a problem share is a problem solved, that was how she directed me to Dr Isibor, that was how i contacted him and get the medication from this doctor and i got cured for real, I just went back to my work and they also carry out the test to be real sure and i was negative. Please contact this doctor if you are herpes positive  diseases his email is: drisiborspellhome@gmail.com 
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  6. i visited different hospital but they gave me list of expensive drugs to treat the symptoms and never cured me. A closed friend of mine introduce me to a Herbal Doctor who cured her. I was scared to contact him because of what i experienced from fake doctors. she encouraged me and gave me his whatsapp contact,and i contacted him and i asked him series of questions, i also ask him to show me the results of those he have cured with his herbal drugs,and he gave me all the information i needed that gave me hope. He send a Herbal medicine to me that i took and it seriously worked for me. am now Hepatitis negative. God bless you for being a sincere and great man. Am so excited and am free from herpes virus. you can reach him via email;dralikaherbalhome@gmail.com or whats-app/call on +2348116570358.

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  7. God bless Dr.CHUKWU MADU for his wonderful work in my life, my name is Helen from USA, I was diagnosed of HERPES since 2016 and it has affected my life i was
    taking my medications, I wasn't satisfied i needed to get the HERPES out of my system, I searched about some possible cure for HERPES i saw a comment about Dr CHUKWU MADU HERBALHOME how he cured HERPES with his herbal medicine, I contacted him and he guided me. I asked for solutions, he started the remedy for my health, he sent me the medicine through UPS delivery company. I took the medicine as prescribed by him and 11 days later i tested negative for HERPES, Dr.CHUKWU MADU truly you are great,It's Good for herpes patient to please read my testimony becuase People think herpes is really a minor skin irritation,herpes has a long term effects on health and The stigma attached to this virus by ignorant people is ridiculous. do you need his help also? Why don't you contact him through his email (dr.chukwumaduherbalhome@gmail.com) or call him on +234703
    0936239, DOCTOR CHUKWU MADU CAN AS WELL CURE THE FOLLOWING DISEASE:- 1. HIV/AIDS 2. HERPES 3. CANCER 4. ALS 5. Hepatitis B AND C 6. Diabetes 7. Athrux, 8. hydrophobia 9.hpv 10 pregnancy spell and bring back your ex back 11 scabies 12. STD. 13.Kidney stone?

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  8. herpes is a serious and recurring disease which can't be cured through drugs or injections by the American doctors but the best way to deal with herpes is by taking natural herbs medicine for it and is only few American doctors that know about this herbal medicine from Dr Akhanene .. I have read about Dr Akhanene the great herbalist doctor from African who can cure disease with his powerful herbal medicine. for the people suffering from the following diseases, Herpes, Cancer, Also,Herpatitis, Diabetes, Hps,Infections ETC should contact him for his herbal medicine because i am a living testimony and i was cured of herpes. Although, i sent him what he requested and he sent me his medicine which i took for 1 weeks and today when i went for test i was tested herpes negative. you can reach him through his Emai drakhanenespellhome@gmail.com.com or whatsapp or call him +2348168714427  

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  9. I want to use this opportunity to thank Dr Oyagu for the grate work he has done for me and my cousin sister, I was cured from herpes virus through his herbal remedy and my cousin sisters was also cured from Cancer. This is a grate testimony for what Dr Oyagu Has done for me and my entire generation. I'm giving this testimony so that those of you out there can contact him while he keeps saving my relatives. Send him a Dm and get a better health totally. Contact him via WhatsApp +2348101755322 or Email address:oyaguherbalhome@gmail.com you can also reach him on his website https://oyaguspellcaster.wixsite.com/oyaguherbalhome

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  10. If you are reading this and you are suffering from HSV or any other disease or you want to fix your broken marriage/relationship or maybe get back with your Ex husband, Ex wife, Boyfriend or girlfriend.. thanks to__________________ [Robinson.buckler@] yahoo. com

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