Vaginal birth of twins after a previous Cesarean section.

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, h 2 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 a...