Trend in cesarean delivery rate among twin pregnancies over a 20 years epoch and the accompanied maternal and perinatal outcomes

Abstract

Objective To examine the trend of cesarean delivery (CD) rate among twin pregnancies and the trend in maternal and neonatal morbidities within two decades. Study design Population-based cohort study, conducted at a single teaching hospital in Israel on data between January 1995 and December 2015. All pregnant women with twin gestation who delivered at a gestational age of 24 weeks or more were included. Data on mode of deliveries, Apgar score <7 at 5 min, cord artery pH < 7.1, early postpartum hemorrhage, blood transfusion, and intrapartum fever for each year were extracted and plotted, and trends were analyzed. CDs performed for one or both twins were divided to laboring, i.e., after a trial of labor, and non-laboring CDs. Data was obtained from the hospital discharge register with ICD-9 codes and crosschecked with the labor medical records. The Cochran-Armitage Trend Test was used to identify trends and correlations. Results Of all 88,145 deliveries that took place during this period, 1955 (2.2%) were twins. Of these 53 were ineligible and were excluded. There was a statistically significant trend (increase) in twins birth over time (p = 0.004). CD rate increased significantly from 43.4% in 1995 to 66.0% in 2015 (p = 0.001). This increase was observed only among non-laboring cesareans (p = 0.001). Multivariate logistic regression analysis revealed that maternal and early neonatal morbidities examined did not differ significantly during the study period. Conclusion Non-laboring CD rate increased significantly over the past two decades among twin pregnancies. Despite this increase, maternal and early neonatal morbidities did not change.

Challenges for better care based on the course of maternal body mass index, weight gain and multiple outcome in twin pregnancies: a population-based retrospective cohort study in Hessen/Germany within 15 years

“…In our cohort, primary caesareans did not increase. Similarly to our results, the increasing caesarean rates in Israel were not combined with lower rates of Apgar score < 7 at 5 min or of PPH during this period [31].…”

“…In central Europe, the rates were 43.9% in the Netherlands, 54.8% in France and 74.8% in Germany. Studies considering changing rates over time were published from Israel, whereby the authors reported on a total increase of caesarean rates in twins from 43.4% in 1995 to 66.0% in 2015 with increasing numbers only in non-laboring women [31]. In our cohort, primary caesareans did not increase.…”

Twin Growth Discordance and Risk of Postpartum Hemorrhage: A Retrospective Cohort Study

“…First, it only included twin pregnancies delivered via cesarean section. Due to physician counseling and maternal requirements for selective cesarean section to avoid combined delivery, the cesarean delivery rate of twin pregnancies has increased dramatically ( 60 – 62 ). In our center, nearly 90% of women with twin pregnancies undergo a cesarean section.…”

Audit of Cesarean section by non-obstetricians in the remote part of Nepal using the Robson classification system.

“…Various studies show that the cesarean section rate is increasing globally. [1][2][3][4][5] Most of the literature and authorities accept a CS rate of 10-15%. If the CS rate is <10% then there is an increased chance of more maternal and neonatal mortality and morbidity due to less access to timely cesarean section facilities.…”