{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:35:15Z","timestamp":1773016515222,"version":"3.50.1"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2023,4,28]],"date-time":"2023-04-28T00:00:00Z","timestamp":1682640000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,4,28]],"date-time":"2023-04-28T00:00:00Z","timestamp":1682640000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Freiburg"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Gynecol Obstet"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>While the optimal delivery method of twin pregnancies is debated, the rate of cesarean deliveries is increasing. This retrospective study evaluates delivery methods and neonatal outcome of twin pregnancies during two time periods and aims to identify predictive factors for the delivery outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>553 twin pregnancies were identified in the institutional database of the University Women\u2019s Hospital Freiburg, Germany. 230 and 323 deliveries occurred in period I (2009\u20132014) and period II (2015\u20132021), respectively. Cesarean births due to non-vertex position of the first fetus were excluded. In period II, the management of twin pregnancies was reviewed; adjusted and systematic training with standardized procedures was implemented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Period II showed significantly lower rates of planned cesarean deliveries (44.0% vs. 63.5%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001) and higher rates of vaginal deliveries (68% vs. 52.4%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02). Independent risk factors for primary cesarean delivery were period I, maternal age\u2009&gt;\u200940\u00a0years, nulliparity, a history with a previous cesarean, gestational age\u2009&lt;\u200937 completed weeks, monochorionicity and increasing birth weight difference (per 100\u00a0g or\u2009&gt;\u200920%). Predictive factors for successful vaginal delivery were previous vaginal delivery gestational age between 34 and 36\u00a0weeks and vertex\/vertex presentation of the fetuses. The neonatal outcomes of period I and II were not significantly different, but planned cesareans in general were associated with increased admission rates to the neonatal intensive care units. Inter-twin interval had no significant impact on neonatal outcome.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Structured regular training of obstetrical procedures may significantly reduce high cesarean rates and increase the benefit\u2013risk ratio of vaginal deliveries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00404-023-07040-6","type":"journal-article","created":{"date-parts":[[2023,4,28]],"date-time":"2023-04-28T03:02:33Z","timestamp":1682650953000},"page":"1441-1452","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Does structured obstetric management play a role in the delivery mode and neonatal outcome of twin pregnancies?"],"prefix":"10.1007","volume":"309","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0389-3049","authenticated-orcid":false,"given":"Isabell","family":"Ge","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Meschede","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ingolf","family":"Juhasz-Boess","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mirjam","family":"Kunze","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Filiz","family":"Markfeld-Erol","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,4,28]]},"reference":[{"issue":"9","key":"7040_CR1","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1055\/s-0038-1668117","volume":"40","author":"DS Santana","year":"2018","unstructured":"Santana DS, Surita FG, Cecatti JG (2018) Multiple pregnancy: epidemiology and association with maternal and perinatal morbidity. 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Still, approval was granted by the Ethics Committee of the University Hospital Freiburg, Germany (Date: May 20, 2021, No. 21-1201).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}