Neonatal mortality in second twin according to cause of death, gestational age, and mode of delivery

Objective The purpose of this study was to assess the risk of neonatal death in the second twin. Study design We carried out a retrospective cohort study of 128,219 live born second twins in the United States for the years 1995 through 1997. The study subjects were divided into 3 groups: second twins who were delivered by cesarean delivery after vaginal delivery of the first twin (group 1), both twins delivered vaginally (group 2), and both twins delivered by cesarean delivery (group 3). Results The risk of asphyxia-related neonatal deaths was increased in groups 1 and 2; the increased risk in group 1 was stronger in term births than in preterm births. Conclusion The risk of neonatal deaths, especially for term infants with asphyxia-related deaths, is increased for the second twins who are delivered by cesarean delivery after vaginal delivery of the first twins.