Correlates of the trend of cesarean section rates in twin pregnancies

Tul, Nataša; Verdenik, Ivan; Trojner-Bregar, Andreja; Novak, Živa; Blickstein, Isaac

doi:10.1515/jpm.2011.129

Cited by 1 publication

(2 citation statements)

References 8 publications

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“…[9][10][11][12] Recent studies state that there is no evidence of better perinatal outcomes for prelabour caesarean delivery versus planned vaginal delivery, as long as the first twin is in the vertex position in an otherwise uncomplicated pregnancy. [13][14][15][16] Despite the lack of evidence, there is a continuing increase in caesarean section rates for twins in many low-, middle-and high-income countries, [17][18][19] and as noted by Blickstein we are in danger of 'a vicious circle in favour of caesarean section', 13 through decreasing experience in vaginal delivery. 20 On the other hand, sub-Saharan Africa seems to be excluded from this trend of increased rates of caesarean section, 21,22 and in many low-and middle-income countries, inequalities in access to caesarean delivery still reflect socio-economic inequities for skilled delivery.…”

Section: Introductionmentioning

confidence: 99%

“…Recent studies state that there is no evidence of better perinatal outcomes for prelabour caesarean delivery versus planned vaginal delivery, as long as the first twin is in the vertex position in an otherwise uncomplicated pregnancy . Despite the lack of evidence, there is a continuing increase in caesarean section rates for twins in many low‐, middle‐ and high‐income countries, and as noted by Blickstein we are in danger of ‘a vicious circle in favour of caesarean section’, through decreasing experience in vaginal delivery …”

Section: Introductionmentioning

confidence: 99%

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Mode and timing of twin delivery and perinatal outcomes in low‐ and middle‐income countries: a secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health

Ganchimeg

Morisaki

Vogel

et al. 2014

BJOG

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Objective To describe the mode and timing of delivery of twin pregnancies at ≥34 weeks of gestation and their association with perinatal outcomes.Design Secondary analysis of a cross-sectional study.Population Twin deliveries at ≥34 weeks of gestation from 21 lowand middle-income countries participating in the WHO Multicountry Survey on Maternal and Newborn Health.Methods Descriptive analysis and effect estimates using multilevel logistic regression.Main outcome measures Stillbirth, perinatal mortality, and neonatal near miss (use of selected life saving interventions at birth).Results The average length of gestation at delivery was 37.6 weeks. Of all twin deliveries, 16.8 and 17.6% were delivered by caesarean section before and after the onset of labour, respectively. Prelabour caesarean delivery was associated with older maternal age, higher institutional capacity and wealth of the country. Compared with spontaneous vaginal delivery, lower risks of neonatal near miss (adjusted odds ratio, aOR, 0.63; 95% confidence interval, 95% CI, 0.44-0.94) were found among prelabour caesarean deliveries. A lower risk of early neonatal mortality (aOR 0.12; 95% CI 0.02-0.56) was also observed among prelabour caesarean deliveries with nonvertex presentation of the first twin. The week of gestation with the lowest rate of prospective fetal death varied by fetal presentation: 37 weeks for vertex-vertex; 39 weeks for vertex-nonvertex; and 38 weeks for a nonvertex first twin.Conclusions The prelabour caesarean delivery rate among twins varied largely between countries, probably as a result of overuse of caesarean delivery in wealthier countries and limited access to caesarean delivery in low-income countries. Prelabour delivery may be beneficial when the first twin is nonvertex. International guidelines for optimal twin delivery methods are needed.

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