title: Cesarean delivery for twins: a systematic review and meta-analysis.
abstract: OBJECTIVE
  We undertook a systematic review and meta-analysis to determine whether a policy of planned cesarean section or vaginal delivery is better for twins.
  
  
  METHODS
  We searched MEDLINE and EMBASE from 1980 through May 2001 using combinations of the following terms: twin, delivery, cesarean section, vaginal birth, birth weight, and gestational age. Studies that compared planned cesarean section to planned vaginal birth for babies weighing at least 1500 g or reaching at least 32 weeks' gestation were included. We computed pooled odds ratios for perinatal or neonatal mortality, low 5-minute Apgar score, neonatal morbidity, and maternal morbidity. The infant was the unit of statistical analysis. Results were considered statistically significant if the 95% CI did not encompass 1.0.
  
  
  RESULTS
  We retrieved 67 articles, 63 of which were excluded. Four studies with a total of 1932 infants were included in the analysis. A low 5-minute Apgar score occurred less frequently in twins delivered by planned cesarean section (odds ratio, 0.47; 95% CI, 0.26-0.88) principally because of a reduction among twins if twin A was in breech position (odds ratio, 0.33; 95% CI, 0.17-0.65). Twins delivered by planned cesarean section spent significantly longer in the hospital (mean difference, 4.01 days; 95% CI, 0.73-7.28 days). There were no significant differences in perinatal or neonatal mortality, neonatal morbidity, or maternal morbidity.
  
  
  CONCLUSIONS
  Planned cesarean section may decrease the risk of a low 5-minute Apgar score, particularly if twin A is breech. Otherwise, there is no evidence to support planned cesarean section for twins.
authors.affiliation: Maternal Infant and Reproductive Health Research Unit at the Centre for Research in Women's Health, Toronto, Ontario, Canada.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Hogle
authors.forename: Eileen K
authors.initials: EK
authors.lastname: Hutton
authors.forename: Kerry A
authors.initials: KA
authors.lastname: McBrien
authors.forename: Jon F r
authors.initials: JF
authors.lastname: Barrett
authors.forename: Mary E
authors.initials: ME
authors.lastname: Hannah
mesh_terms: D001034:Apgar Score; D001724:Birth Weight; D002585:Cesarean Section; D005260:Female; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D016239:MEDLINE; D008428:Maternal Mortality; D011247:Pregnancy; D014427:Twins