title: Fertility treatment as a risk factor for maternal request of cesarean delivery in twin pregnancies.
abstract: A marked increase in the overall cesarean delivery (CD) rate of twin pregnancies has recently been observed. We sought to examine the obstetrical characteristics of patients who chose a non-indicated CD and to investigate the trends in the rate of CD for maternal request over a 5 years period.
  
  
  
  A cross sectional retrospective study of twin pregnancies, compared obstetrical characteristics between patients who chose a non-indicated CD and those who delivered vaginally. Deliveries occurred during 2006 and 2011 in a regional tertiary medical center. Patients with any indication for a CD were excluded. A multivariate logistic regression was used to control for confounders.
  
  
  
  525 twins were included at the study, 61.7 % (n = 324) were delivered by CD. Of these, 28.7 % (n = 93) were non-indicated. Between the years 2006 and 2011, there was a significant decrease in the rate of non-indicated CD (34.9 vs 23.8 %, OR = 0.58, 95 % CI 0.35-0.94, P = 0.02). Deliveries after fertility treatments or a previous CD had a higher rate of non-indicated CD (51.6 vs. 27.4 %, P < 0.001 and 26.9 vs. 3.5 %, P < 0.001; respectively). In the multivariate analysis, maternal age (OR = 1.08, 95 % CI 1.01-1.15), previous CD (OR = 15.75, 95 % CI 5.82-42.67) and fertility treatments (OR = 2.16, 95 % CI 1.14-4.10) were found to be independent risk factors for a non-indicated CD. Furthermore, parity was found to be an independent protective factor (OR = 0.75, 95 % CI 0.61-0.92).
  
  
  
  In our study population, there was a significant decrease in the rate of non-indicated CD over a five-year period. Maternal age, fertility treatments and previous CD were found to be independent risk factors for non-indicated CD in twin pregnancies.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, Beer Sheva, 84101, Israel. okby@bgu.ac.il.
authors.forename: Rania
authors.identifier: 0000-0002-4468-8172
authors.initials: R
authors.lastname: Okby
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, Beer Sheva, 84101, Israel.
authors.forename: Yura
authors.initials: Y
authors.lastname: Druyan
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, Beer Sheva, 84101, Israel.
authors.forename: Molly
authors.initials: M
authors.lastname: Sonenklar
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, Beer Sheva, 84101, Israel.
authors.forename: Barak
authors.initials: B
authors.lastname: Aricha-Tamir
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, Beer Sheva, 84101, Israel.
authors.forename: Kira Nahum
authors.initials: KN
authors.lastname: Sacks
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, Beer Sheva, 84101, Israel.
authors.forename: Eyal
authors.initials: E
authors.lastname: Sheiner
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000379:methods*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007246:Infertility / Q000628:therapy*; D011247:Pregnancy; D059285:Pregnancy, Twin; D012189:Retrospective Studies; D012307:Risk Factors; D014427:Twins
keywords: Cesarean delivery; Maternal request; Twin pregnancy