title: Mode of delivery in non-cephalic presenting twins: a systematic review.
abstract: OBJECTIVE
  This systematic review aims to determine if there are evidence-based recommendations for the optimal mode of delivery for non-cephalic presenting first- and/or second twins. We investigated the impact of the mode of delivery on neonatal outcome for twin deliveries with (1) the first twin (twin A) in non-cephalic presentation, (2) the second (twin B) in non-cephalic presentation and (3) both twins in non-cephalic presentation.
  
  
  METHODS
  A computer-aided search of Medline, Embase, Cinahl and Cochrane databases was carried out and quality of the studies was assessed with the Cochrane Collaboration's tool for assessing risk of bias and the GRADE approach.
  
  
  RESULTS
  One high-quality clinical trial (60 twin pairs) and 16 moderate/low-quality observational studies (3,167 twin pairs) showed no difference in neonatal outcome between vaginal and caesarean delivery in twin A and/or B.
  
  
  CONCLUSIONS
  Our results do not suggest benefit of caesarean over vaginal delivery for selected twin gestations with twin A and/or twin B in non-cephalic presentation. However, no final conclusion can be drawn due to the small sample sizes and statistic limitations of the included studies. Randomized studies with sufficient power are required to make a strong recommendation.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands. c.n.steinsbisschop@umcutrecht.com
authors.forename: Charlotte N
authors.initials: CN
authors.lastname: Steins Bisschop
authors.forename: Tatjana E
authors.initials: TE
authors.lastname: Vogelvang
authors.forename: Anne M
authors.initials: AM
authors.lastname: May
authors.forename: Nico W E
authors.initials: NW
authors.lastname: Schuitemaker
mesh_terms: D001034:Apgar Score; D001946:Breech Presentation / Q000628:therapy*; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D011247:Pregnancy; D059285:Pregnancy, Twin