Rates of Cesarean Conversion in Planned Vaginal Twin Deliveries: Do We Need the Operating Room? [39Q]

INTRODUCTION: We aimed to investigate rates of cesarean conversion for planned twin VDs and identify predictors and outcomes of conversion. METHODS: A retrospective cross-sectional study of women who underwent planned twin VD at a large academic hospital over four years (IRB#18-000872). Demographic and outcome data were chart abstracted. Logistic regression was used to analyze predictors of conversion and Welch two-sample t- test was used to compare outcomes. RESULTS: 405 twin deliveries were identified; 60 (14.8%) were planned VD. Of these, 40 (66.7%) were cephalic/cephalic and 20 (33.3%) cephalic/breech presentation. Median maternal age was 33.9 years (IQR 31.6-35.9). Median gestational age (GA) was 36 weeks (IQR 35-38). Conversion to cesarean delivery (CD) occurred in 4 planned VDs (6.7%). Of these, 1 (1.7%) was emergent for fetal bradycardia and 3 (5%) were for malpresentation of Twin B, 2 of which involved providers inexperienced with breech extractions of second twin. There were no significant predictors of conversion to CD, including BMI, maternal age, antepartum length of stay (LOS), GA at delivery, parity, presentation, or type of OB provider. There was no correlation between conversion to CD and postpartum LOS (P=0.12). There were no correlations with neonatal APGARs at 1 and 5 minutes for twin A (P=0.26, P=0.75) or twin B (P=0.86, P=0.51). CONCLUSION: Successful VD is achieved in 93.3% of planned VD of twins. Need for emergent conversion to CD, requiring immediate OR availability, is very low. Planned vaginal twin deliveries can be safely performed in Labor and Delivery rooms to optimize costs and resource utilization.