The Likelihood of Change in Fetal Presentation During the Third Trimester in Twin Pregnancies.
Obstet Gynecol
; 126(6): 1231-1236, 2015 Dec.
Article
em En
| MEDLINE
| ID: mdl-26551181
ABSTRACT
OBJECTIVE:
To estimate the likelihood and identify predictors of spontaneous fetal version during the third trimester in twins using data from a multicenter randomized controlled trial on mode of delivery in twin pregnancies.METHODS:
Women with twin pregnancies after 32 weeks of gestation in which twin A was vertex were randomized to planned cesarean or planned vaginal delivery. In the current study we analyzed the likelihood of a spontaneous version of any of the twins between ultrasound assessment at the time of randomization and delivery.RESULTS:
A total of 2,603 women were analyzed. Twin A tended to persist in the vertex presentation after 32 weeks of gestation with a spontaneous version rate to nonvertex presentation of 3.0% (95% confidence interval [CI] 2.3-3.7%). Twin B was less stable and underwent spontaneous version in 24.8% (95% CI 23.1-26.5%) of cases; the rate remained higher than 20% even after 34 weeks of gestation. On multivariable analysis, twin A was more likely to undergo version when twin B was smaller (adjusted odds ratio [OR] 2.0, 95% CI 1.04-3.3), when twin B was breech (adjusted OR 3.7, 95% CI 2.2-6.4) or transverse (adjusted OR 2.9, 95% CI 1.6-5.5), and when the interval to delivery exceeded 4 weeks (adjusted OR 2.5, 95% CI 1.3-5.0). Twin B was more likely to undergo version when it was in the breech presentation (adjusted OR 1.7, 95% CI 1.4-2.1) or transverse lie (adjusted OR 3.1, 95% CI 2.5-3.9) compared with vertex presentation, when it was smaller (adjusted OR 1.7, 95% CI 1.1-2.0), when the interval to delivery exceeded 4 weeks (adjusted OR 1.7, 95% CI 1.3-2.4), and in multiparous women (adjusted OR 1.3, 95% CI 1.04-1.5).CONCLUSION:
The likelihood of spontaneous version of twin A after 32 weeks of gestation is low when twin A is in the vertex presentation but is much higher for twin B, even late during the third trimester. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, www.clinicaltrials.gov, NCT00187369. LEVEL OF EVIDENCE II.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Terceiro Trimestre da Gravidez
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Gravidez de Gêmeos
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Apresentação no Trabalho de Parto
Tipo de estudo:
Clinical_trials
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Diagnostic_studies
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Etiology_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Female
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Humans
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Pregnancy
Idioma:
En
Revista:
Obstet Gynecol
Ano de publicação:
2015
Tipo de documento:
Article
País de afiliação:
Canadá