[What type of delivery for twins?].
OBJECTIVE
To determine if perinatal and neonatal morbidity and mortality is improved by a planned caesarean section for twins before and at term.


METHODS
A systematic search was conducted in Medline between May 2001 and December 2008. Randomised controlled studies and meta-analysis were researched at first.


RESULTS
There is no evidence to support a policy of planned caesarean section or vaginal delivery for twins before term or at term whatever the presentation of the first twin. There is also no evidence to support a policy of caesarean section or vaginal delivery for a patient with a history of prior caesarean section. Vaginal delivery must be made in the presence of an obstetrician, an anaesthesiologist, and a paediatrician in a level maternity adapted to the risks of the future newborn.


CONCLUSIONS
Otherwise, there is no evidence to support a policy of planned caesarean delivery for twins but the type of delivery has to be decided with the informed patient.
Pôle de gynécologie-obstétrique et reproduction, CHU de Clermont-Ferrand, Hôtel-Dieu, Boulevard Léon-Malfreyt, 63000 Clermont-Ferrand, France. fvendittelli@chu-clermontferrand.fr
F
F
Vendittelli
M
M
Accoceberry
D
D
Savary
H
H
Laurichesse-Delmas
D
D
Gallot
B
B
Jacquetin
D
D
Lémery
D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D059285:Pregnancy, Twin