When possible, vaginal delivery induces fewer complications than cesarean section in twin pregnancies.
Neonatal mortality, that is, for infants less than 27 days old, is between five and ten times higher in twins. Hypertension, growth retardation, premature delivery, placental abruption, poor placement of the umbilical cord …
These complications sometimes lead doctors and parents to prefer a Caesarean section as the method of delivery, which is considered safer for these high-risk pregnancies.
But this idea is not necessarily a good idea, believe researchers from Inserm, the University of Paris-Descartes and the AP-HP. The rate of complications is even higher after a scheduled cesarean section than after an attempted vaginal birth, for children born between the 32nd and 37th week of pregnancy.
Mortality doubled
Within a study named JUMODA, of which the results appear in Obstetrics and Gynecology, more than 8,800 women pregnant with twins were recruited in France, between February 2014 and March 2015. Among those who had planned a caesarean, the mortality of at least one of the two children was 5.2%, against only 2.2% for vaginal birth plans (although 20% of these ended up with a cesarean).
If these results are different from those observed so far, it is because of the differences in the methods of childbirth between France and the Anglo-Saxon countries, where most of the studies on the subject had until then been carried out. , estimates Professor Thomas Schmitz, gynecologist-obstetrician at the Robert-Debré hospital, in Paris, and one of the authors of the study.
An informed choice
Even if the cesarean section remains a sometimes unavoidable backup solution, these results, obtained in the case where the first baby was in the head down position, work in favor of a vaginal delivery, which seems half the risk.
In addition, research on the microbiota has shown that the baby’s contact with its mother’s vaginal bacteria at the time of birth triggers many immune mechanisms, essential for long-term health.
“The message we would like to send to patients who are pregnant with twins is that twin pregnancy is not in itself an indication for a cesarean delivery,” explains Professor Thomas Schmitz. We believe it is important that patients who are pregnant with twins be informed of these results so that they can best discuss their delivery route with their obstetrician. “
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