title: Clinical indicators associated with the mode of twin delivery: an analysis of 22,712 twin pairs.
abstract: OBJECTIVE
  To identify clinical indicators associated with the planned and actual mode of delivery in women with a twin pregnancy.
  
  
  METHODS
  We performed a retrospective cohort study in women with a twin pregnancy who delivered at a gestational age of 32+0-41+0 weeks and days between 2000 and 2008 in the Netherlands. Data were obtained from a nationwide database. We identified maternal, pregnancy-related, fetal, neonatal and hospital-related indicators that were associated with planned cesarean section (CS) and, for women with planned vaginal delivery (VD), for intrapartum CS. The associations between indicators and mode of delivery were studied with uni- and multivariate logistic regression analyses.
  
  
  RESULTS
  We included 22,712 women with a twin pregnancy, of whom 4,310 women (19.0%) had a planned CS. Of the 18,402 women who had a planned VD, 14,034 (76.3%) delivered vaginally, 3,545 (19.3%) had an intrapartum CS, while 823 (4.5%) delivered twin A vaginally and twin B by intrapartum CS. The clinical indicators for a planned CS and an intrapartum CS were comparable: non-cephalic position of both twins (aOR 25.32; 95% CI 22.50-28.50, and aOR 21.94; 95% CI 18.67-25.78, respectively), non-cephalic position of twin A only (aOR 21.67 95% CI 19.12-24.34, and aOR 13.71; 95% CI 11.75-16.00, respectively), previous CS (aOR 3.69; 95% CI 3.12-4.36, and aOR 7.00; 95% CI 5.77-8.49, respectively), nulliparity (aOR 1.51; 95% CI 1.32-1.72, and aOR 4.20; 95% CI 3.67-4.81, respectively), maternal age ≥41 years (aOR 3.00; 95% CI 2.14-4.22, and aOR 2.50; 95% CI 1.75-3.59, respectively), and pre-eclampsia (aOR 2.12; 95% CI 1.83-2.46, and aOR 1.34; 95% CI 1.16-1.56, respectively).
  
  
  CONCLUSIONS
  Both planned and intrapartum CS in twins had comparable predictors: non-cephalic position of both twins or twin A only, previous CS, nulliparity, advanced maternal age, and pre-eclampsia.
authors.affiliation: Department of Obstetrics and Gynecology, Atrium Medical Center Parkstad, Heerlen, The Netherlands. Electronic address: simonegoossens@gmail.com.
authors.forename: Simone M T A
authors.initials: SMTA
authors.lastname: Goossens
authors.affiliation: Netherlands Perinatal Registry, Utrecht, The Netherlands.
authors.forename: Chantal W P M
authors.initials: CWPM
authors.lastname: Hukkelhoven
authors.affiliation: Netherlands Perinatal Registry, Utrecht, The Netherlands.
authors.forename: Lotte
authors.initials: L
authors.lastname: de Vries
authors.affiliation: The Robinson Institute, School of Pediatrics and Reproductive Health, University of Adelaide, Australia.
authors.forename: Ben Willem
authors.initials: BW
authors.lastname: Mol
authors.affiliation: Department of Obstetrics and Gynecology, Maastricht University Medical Center, GROW - School for Oncology and Developmental Biology, The Netherlands.
authors.forename: Jan G
authors.initials: JG
authors.lastname: Nijhuis
authors.affiliation: Department of Obstetrics and Gynecology, Atrium Medical Center Parkstad, Heerlen, The Netherlands.
authors.forename: Frans J M E
authors.initials: FJME
authors.lastname: Roumen
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007746:Labor Presentation; D016015:Logistic Models; D008423:Maternal Age; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D010298:Parity; D011225:Pre-Eclampsia / Q000453:epidemiology*; D011247:Pregnancy; D059285:Pregnancy, Twin / Q000706:statistics & numerical data*; D012042:Registries; D012189:Retrospective Studies; D055815:Young Adult
keywords: Cesarean section; Clinical indicator; Decision; Twin delivery