C-Section Planning Not Necessary for Twins

A new study has concluded that planned vaginal delivery for twins is just as safe as planned cesarean section.

Researchers at Sunnybrook Research Institute (Toronto, Canada) randomly assigned a total of 2,804 women with twin pregnancy (and the first twin in the cephalic presentation) to planned cesarean section (1,398 women, 2,795 fetuses) or planned vaginal delivery (1,406 women, 2812 fetuses) with cesarean only if indicated. The women were between 32 weeks and 38 weeks 6 days of gestation, and elective delivery was planned between 37 weeks 5 days and 38 weeks 6 days of gestation. The primary outcome was a composite of fetal or neonatal death or serious neonatal morbidity.

The results showed that the rate of cesarean delivery was 90.7% in the planned-cesarean-delivery group and 43.8% in the planned-vaginal-delivery group, which was reassessed at the time of labor. As a result, 40% of cases shifted to medically indicated cesarean for both twins (30% during labor) and 4% for one twin only. The planned cesarean delivery route actually showed a 16% greater risk of fetal or neonatal death or serious neonatal morbidity, compared with planned vaginal delivery (2.2% versus 1.9%, respectively). The study was published in the October 3, 2013, issue of the New England Journal of Medicine (NEJM).

“Women in the planned-cesarean-delivery group delivered one day earlier than did those in the planned-vaginal-delivery group,” concluded lead author Jon Barrett, MBBCh, MD, and colleagues, who were reticent of their results. “Given the trends in patient demographic characteristics and preferences, the virtual disappearance of vaginal delivery in cases of breech presentation, and the dramatic reduction in instrumented vaginal delivery (and the associated gradual disappearance of the skills necessary to perform these procedures among obstetricians), it seems unlikely that we will see a major change in use of cesarean delivery for twins nationwide.”

Related Links:
Sunnybrook Research Institute