Is a planned cesarean necessary in twin pregnancies?

ABSTRACT

OBJECTIVE: Evaluation of elective cesarean section for twin delivery as a standard of care. DESIGN: Historical cohort in a national database (2 597 twin pregnancies). SETTING: France. SAMPLE Twins with first child in cephalic presentation. METHODS: Decision analysis. MAIN OUTCOME MEASURES: All neonatal complications, i.e. death, whether intrapartum or in the delivery room or the immediate postpartum period, or neonatal transfer to intensive (or special) care, or trauma, of one or both twins. RESULTS: When we focused on neonatal complications for either or both twins, the strategy of planned vaginal delivery was preferable; the weight of its decision tree branch was lower than that for planned cesarean (26.5 vs. 31.7). If only twin 2 was considered, vaginal delivery was also preferred (weight of vaginal delivery=27.6 vs. 32.7 for planned cesarean). As long as the morbidity and mortality of twin 1 or twin 2 or both during a cesarean for twin 2 in the case of planned vaginal delivery does not exceed 31.5%, all else being equal, vaginal delivery should be preferred to a planned cesarean for twin 1 and twin 2. The two-variable sensitivity analysis confirmed the robustness of the results. CONCLUSIONS: The results of our study do not support a policy of planned cesarean delivery for twin pregnancies at and after 34 weeks of gestation. LEVEL OF EVIDENCE II.