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Mode of delivery of twins

Fetal Medicine Service, Addenbrookes NHS Trust, Cambridge, UK.

Gordon CS Smith, MD MRCOG PhD, Professor of Obstetrics and Gynaecology

Department of Obstetrics and Gynaecology, Rosie Maternity Hospital, Robinson Way, Cambridge University, Cambridge, CB2 2SW, UK. email: gcss2{at}cam.ac.uk(corresponding author)

Perinatal mortality is five times higher in twins than in singletons. This increased risk is mainly owing to factors unrelated to mode of delivery. Nevertheless, vaginal birth of twins at term is well recognised as a high-risk area. It is associated with increased rates of perinatal death and a depressed Apgar score, primarily because of intrapartum asphyxia of the second twin. It is plausible that planned caesarean section may have a protective effect on these outcomes but there is a lack of direct evidence in this area. This review outlines some issues to raise when counselling and planning twin birth at term.

Keywords Keywords / intrapartum management / mode of delivery / perinatal death / risks / twin birth