Twin births: cesarean section or vaginal delivery?

Area of Science:

• Obstetrics and Gynecology
• Perinatal Medicine
• Maternal-Fetal Medicine

Background:

• Twin pregnancies present unique challenges in delivery management.
• Chorionicity and mode of delivery are critical factors influencing perinatal outcomes in twin gestations.

Purpose of the Study:

• To evaluate the association between chorionicity, mode of delivery, and adverse perinatal outcomes in twin pregnancies.
• To compare morbidity and mortality rates in dichorionic and monochorionic twins based on delivery method.

Main Methods:

• Retrospective cohort study of 1,175 twin pregnancies with two live fetuses at ≥36 weeks gestation.
• Data collected from 14 Danish obstetric departments.
• Poor outcome defined by Apgar score, umbilical artery pH, neonatal unit admission duration, or death.

Main Results:

• Dichorionic (DC) twins with intended vaginal delivery had a higher risk of poor outcome compared to planned cesarean section (OR 1.47).
• No significant difference in poor outcome risk was observed for monochorionic (MC) twins based on delivery mode.
• Nulliparity and birthweight discordance >300g increased poor outcome risk in both DC and MC twins. The second-born DC twin had a higher risk of poor outcome than the first.

Conclusions:

• Intended vaginal delivery for dichorionic twins after 36 weeks gestation is associated with a higher risk of adverse outcomes compared to planned cesarean section.
• Mode of delivery did not significantly impact outcomes for monochorionic twins in this cohort.