Planned Cesarean No Safer Than Vaginal Delivery for Twins

A planned cesarean delivery in twin pregnancy does not increase or decrease risks to the unborn fetuses when compared with a planned vaginal delivery, according to the results of a randomized controlled trial. The study, published in the October 3 issue of the New England Journal of Medicine, shows that among pregnant mothers of twins between 32 weeks 0 days and 38 weeks 6 days of gestation and whose first twin is in the cephalic presentation, choosing to have a planned cesarean delivery does not affect the risks for fetal or neonatal death or serious neonatal morbidity when compared with choosing to deliver the twins vaginally.

"These results do not indicate that all sets of twins should be delivered vaginally." Michael Greene, MD, notes in an accompanying editorial. "Obstetricians exercising their best clinical judgment delivered both twins by cesarean section in nearly 40% of the women assigned to planned vaginal delivery, which undoubtedly contributed to the salutary outcomes," he writes. "However, the results of this study suggest that a plan to deliver appropriately selected sets of twins vaginally is a reasonably safe choice in skilled hands."
"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," he concludes.