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Friday, 1 November, 2002, 00:42 GMT
Natural birth 'puts twins at risk'
There are currently no guidelines for delivering twins
Twins should be delivered by Caesarean section to reduce the risk of infants dying, a study suggests.

Doctors in the UK have found evidence to suggest that natural births at full term can put the twin who is born second at risk.

Their study found that the second twin is up to eight times more likely to die if it is born naturally.


This may well be enough to tip the balance for most obstetricians

Prof Nick Fisk,
Queen Charlotte's Hospital London
The doctors said their findings suggested women who are expecting twins should consider having a Caesarean birth.

Gordon Smith, professor of obstetrics and gynaecology at Cambridge University, and colleagues analysed 4,500 twin births in Scotland between 1992 and 1997.

They found that twins who are born second using natural delivery methods were more likely to die than those delivered by Caesarean.

High death rates

Overall, one in every 270 second twins died during natural childbirth at full-term, many because of a lack of oxygen.

This is significantly higher than babies who are not twins. Just one in 1,000 singleton babies born to women who have never given birth before die.

Among women who have given birth before, the figure is even lower - just one in every 2,000.

The researchers also carried out a second study to see if caesareans reduced the risks of death in twins born second.

Their study of 454 twin caesarean births found none of the babies born second died.

The researchers acknowledged that the study was small but said it suggested that Caesareans had a "protective effect" for second twins.

They said their findings indicated that women who are expecting twins should be told of the risks of having a natural birth.

Writing in the British Medical Journal, they said: "We propose that women with twins should be counselled about the risk to the second twin and the theoretical possibility of a protective effect of planned Caesarean section when considering mode of delivery at term."

'Tip the balance'

Professor Nick Fisk of Queen Charlotte's Hospital in London welcomed the study which indicated that Caesareans are safer for twins.

He suggested the findings could prompt doctors to carry out more Caesarean sections on women pregnant with twins.

There are currently no guidelines on delivering twins for doctors in the UK.

"This may well be enough to tip the balance for most obstetricians towards recommending and offering Caesarean sections to women pregnant with twins," he told BBC News Online.

See also:

02 Jul 02 | Health
26 Oct 01 | Health
21 May 01 | Health
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