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OBJECTIVE:: To determine perinatal complications in infants =4500?g according to delivery mode. STUDY DESIGN:: Records of 231 mothers and live cephalic infants weighing =4500?g over a 13-year period were retrospectively reviewed. Maternal and perinatal complications were compared in relation to delivery mode. RESULTS:: Vaginal delivery (NVD) was achievable in 168/189 (88.9%) of women allowed to labor, of which 36.9% were operative. The cesarean delivery (CS) rate was 27.3%. The NVD group had a lower incidence of diabetes; however, hypoglycemia and transient tachypnea were more common in the CS group. The frequency of low Apgar scores at 1 and 5?minutes was similar in both groups. A total of 13 (7.7%) major fetal injuries were documented in the NVD group (arm weakness 3, hematoma 3, clavicular fracture 2, and brachial plexus injury 5). Shoulder dystocia was documented in only 7/13 (53.8%). CONCLUSION:: Vaginal delivery is achievable in 88.9% of pregnancies with infants =4500?g allowed to labor, at the expense of a 7.7% risk of perinatal trauma.Journal of Perinatology (2003) 23, 136-141. doi:10.1038/sj.jp.7210877 [ABSTRACT FROM AUTHOR]

OBJECTIVE: To compare the perinatal outcome of the presenting twin to its co - twin. STUDY DESIGN: All live nonanomalous twin gestations delivered at >25 weeks' gestation between 1984 and 1994 ( N = 461 ) were identified. Twin A was compared to twin B regarding the following variables: presentation, Apgar score ( AS ) < 4 at 1 minute, AS < 7 at 5 minutes, birth weight, gender, traumatic delivery, meconium - stained amniotic fluid, cord prolapse, need for mechanical ventilation, intraventricular hemorrhage, respiratory distress syndrome, sepsis, seizures, perinatal mortality, and length of nursery stay. RESULTS: Except for differences in presentation, the perinatal outcome was similar in both twins regarding variables studied. This continued to hold true after subdividing according to mode of delivery, when infants with birth weight ≤1500 g were considered separately, and when vaginally delivered cephalic twin A was compared to the noncephalic co - twin. However, differences in some outcome variables became evident when pregnancies with only one affected member were analyzed separately. CONCLUSIONS: When all twin pairs are considered, the outcome of the second - born twin is similar to that of the first - born regardless of the mode of delivery, presentation, or birth weight ≤1500 g. If only those twin pairs with one affected and one unaffected twin are considered, it becomes apparent that the presenting twin is at increased risk for infection - related morbidities whereas the co - twin is at risk for other complications. [ABSTRACT FROM AUTHOR]