title: Risk factors for cesarean delivery in twin pregnancies attempting vaginal delivery.
abstract: OBJECTIVE
  The purpose of this study was to estimate independent risk factors for cesarean delivery in patients with twin pregnancies who attempt vaginal delivery.
  
  
  METHODS
  This was an historic cohort of twin pregnancies that were delivered in 1 practice from June 2005 to February 2014. Baseline characteristics were compared between women who delivered vaginally and women who underwent cesarean delivery in labor. Logistic regression analysis was performed to estimate independent risk factors for cesarean delivery.
  
  
  RESULTS
  Two hundred eighty-six women with twin pregnancies who had attempted vaginal delivery were included in the study. The overall modes of delivery were vaginal delivery (82.2%), cesarean delivery (17.8%), and combined vaginal-cesarean delivery (0%). The most common indication for cesarean delivery in labor was an arrest disorder (82.4%). The risk factors that were associated independently with cesarean delivery were nulliparity (adjusted odds ratio, 5.78; 95% confidence interval, 2.24-14.88) and advanced maternal age of ≥35 years (adjusted odds ratio, 2.36; 95% confidence interval, 1.16-4.80). The patients at highest risk for cesarean delivery (nulliparous, advanced maternal age, induced labor) still had a 48.6% likelihood of vaginal delivery.
  
  
  CONCLUSIONS
  In patients with twin pregnancies who attempt labor, nulliparity and advanced maternal age are associated independently with cesarean delivery in labor. However, even the patients at highest risk for cesarean delivery have nearly a 50% likelihood of successful vaginal delivery and therefore should be allowed to attempt vaginal delivery if it is desired and not otherwise contraindicated.
authors.affiliation: Maternal Fetal Medicine Associates, PLLC, New York, and the Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: nfox@mfmnyc.com.
authors.forename: Nathan S
authors.initials: NS
authors.lastname: Fox
authors.affiliation: Maternal Fetal Medicine Associates, PLLC, New York, and the Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Simi
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Maternal Fetal Medicine Associates, PLLC, New York, and the Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Melka
authors.affiliation: Maternal Fetal Medicine Associates, PLLC, New York, and the Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Michael
authors.initials: M
authors.lastname: Silverstein
authors.affiliation: Maternal Fetal Medicine Associates, PLLC, New York, and the Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Samuel
authors.initials: S
authors.lastname: Bender
authors.affiliation: Maternal Fetal Medicine Associates, PLLC, New York, and the Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Saltzman
authors.affiliation: Maternal Fetal Medicine Associates, PLLC, New York, and the Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Chad K
authors.initials: CK
authors.lastname: Klauser
authors.affiliation: Maternal Fetal Medicine Associates, PLLC, New York, and the Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Andrei
authors.initials: A
authors.lastname: Rebarber
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D011247:Pregnancy; D059285:Pregnancy, Twin; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors
keywords: advanced maternal age; cesarean delivery; labor; nulliparity; twins