title: Is a planned cesarean necessary in twin pregnancies?
abstract: OBJECTIVE
  Evaluation of elective cesarean section for twin delivery as a standard of care.
  
  
  METHODS
  Historical cohort in a national database (2 597 twin pregnancies).
  
  
  METHODS
  France.
  
  
  METHODS
  Twins with first child in cephalic presentation.
  
  
  METHODS
  Decision analysis.
  
  
  METHODS
  All neonatal complications, i.e. death, whether intrapartum or in the delivery room or the immediate postpartum period, or neonatal transfer to intensive (or special) care, or trauma, of one or both twins.
  
  
  RESULTS
  When we focused on neonatal complications for either or both twins, the strategy of planned vaginal delivery was preferable; the weight of its decision tree branch was lower than that for planned cesarean (26.5 vs. 31.7). If only twin 2 was considered, vaginal delivery was also preferred (weight of vaginal delivery=27.6 vs. 32.7 for planned cesarean). As long as the morbidity and mortality of twin 1 or twin 2 or both during a cesarean for twin 2 in the case of planned vaginal delivery does not exceed 31.5%, all else being equal, vaginal delivery should be preferred to a planned cesarean for twin 1 and twin 2. The two-variable sensitivity analysis confirmed the robustness of the results.
  
  
  CONCLUSIONS
  The results of our study do not support a policy of planned cesarean delivery for twin pregnancies at and after 34 weeks of gestation.
  
  
  METHODS
  II.
authors.affiliation: AUDIPOG (Association of Health Workers Using an Electronic File in Paediatrics, Obstetrics and Gynaecology), Medical University RTH Laennec, Lyon, France. fvendittelli@chu-clermontferrand.fr
authors.forename: Françoise
authors.initials: F
authors.lastname: Vendittelli
authors.forename: Olivier
authors.initials: O
authors.lastname: Rivière
authors.forename: Catherine
authors.initials: C
authors.lastname: Crenn-Hébert
authors.forename: Didier
authors.initials: D
authors.lastname: Riethmuller
authors.forename: Jean-Patrick
authors.initials: JP
authors.lastname: Schaal
authors.forename: Michel
authors.initials: M
authors.lastname: Dreyfus
mesh_terms: D002585:Cesarean Section / Q000379:methods*; D015331:Cohort Studies; D016208:Databases, Factual; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods; D017558:Elective Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D007746:Labor Presentation; D008423:Maternal Age; D011247:Pregnancy; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple; D011295:Prenatal Care / Q000379:methods; D012680:Sensitivity and Specificity; D014427:Twins