Trends in twin pregnancies and mode of delivery during the last 30 years: inconsistency between guidelines and clinical practice

Abstract

Despite the lack of adequate scientific evidence concerning the optimal route of delivery in twin pregnancies it seems that over time cesarean section has become the standard of care in most of twin pregnancies. Changes in the demographic characteristics contribute among other factors to this practice.

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

“…Observational studies using existing data sets covering births of routine clinical practice should be further explored for supportive evidence. Our findings, as supported by other studies, 17,[20][21][22] show that experience and preference, as well as disparities in access to care, may be significant determinants as to who delivers by prelabour caesarean delivery. Only seven (25%) countries had significantly higher rates of prelabour caesarean section for nonvertex first-twin presentation, compared with vertex-vertex presentation.…”

“…[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.…”

The Effects of Poor Neonatal Health on Children's Cognitive Development

“…It is important to note that twins differ from singletons in important ways. Twins have a lower mean gestational age and a lower mean birth weight than singletons; they have older and more educated mothers, as well as mothers who are more likely to be married (Antsaklis, Malamas, and Sindos 2013). We discuss issues of external validity in the conclusion.…”

Clinical factors associated with failed trials of labor in late preterm and term twin pregnancies

“…In planning the mode of delivery in twin pregnancies, a trial of labor (TOL) can be challenging in modern obstetrics due to the possible complications during labor and in the delivery of the second twin, as well as inexperience of obstetricians resulting in disqualification of breech extraction [4]. Although a planned cesarean section is considered protective against unpredictable adverse events during labor, it is not yet proven, with current evidence that planned cesarean delivery is indeed beneficial for obstetric outcomes.…”