G Justus Hofmeyr1, Jon F Barrett, Caroline A Crowther. 1. Department of Obstetrics and Gynaecology, East London Hospital Complex, University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health, Frere and Cecilia Makiwane Hospitals, Private Bag X 9047, East London, Eastern Cape, South Africa, 5200.
Abstract
BACKGROUND: Twin pregnancies are associated with increased perinatal mortality, mainly related to prematurity, but complications during birth may contribute to perinatal loss or morbidity. The option of planned caesarean section to avoid such complications must therefore be considered. On the other hand, randomised trials of other clinical interventions in the birth process to avoid problems related to labour and birth (planned caesarean section for breech, and continuous electronic fetal heart rate monitoring), have shown an unexpected discordance between short-term perinatal morbidity and long-term neurological outcome. The risks of caesarean section for the mother in the current and subsequent pregnancies must also be taken into account. OBJECTIVES: To determine the short- and long-term effects on mothers and their babies, of planned caesarean section for twin pregnancy. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2011). SELECTION CRITERIA: Randomised trials comparing a policy of caesarean section with planned vaginal birth for women with twin pregnancy. DATA COLLECTION AND ANALYSIS: Two researchers independently assessed eligibility, quality and extracted data. Data were checked for accuracy. MAIN RESULTS: One small trial with unconfirmed allocation concealment compared caesarean section with planned vaginal birth in 60 women with vertex/non-vertex twin pregnancies. There were no differences in perinatal outcome. The trial was too small to exclude the possibility of clinically meaningful benefits of either approach. There is one additional trial currently ongoing. AUTHORS' CONCLUSIONS: There is a lack of robust evidence to guide clinical advice regarding the method of birth for twin pregnancies. Women should be informed of possible benefits and risks of either approach, including short-term and long-term consequences for both mother and babies. Future research should aim to provide unbiased evidence, including long-term outcomes.
BACKGROUND: Twin pregnancies are associated with increased perinatal mortality, mainly related to prematurity, but complications during birth may contribute to perinatal loss or morbidity. The option of planned caesarean section to avoid such complications must therefore be considered. On the other hand, randomised trials of other clinical interventions in the birth process to avoid problems related to labour and birth (planned caesarean section for breech, and continuous electronic fetal heart rate monitoring), have shown an unexpected discordance between short-term perinatal morbidity and long-term neurological outcome. The risks of caesarean section for the mother in the current and subsequent pregnancies must also be taken into account. OBJECTIVES: To determine the short- and long-term effects on mothers and their babies, of planned caesarean section for twin pregnancy. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2011). SELECTION CRITERIA: Randomised trials comparing a policy of caesarean section with planned vaginal birth for women with twin pregnancy. DATA COLLECTION AND ANALYSIS: Two researchers independently assessed eligibility, quality and extracted data. Data were checked for accuracy. MAIN RESULTS: One small trial with unconfirmed allocation concealment compared caesarean section with planned vaginal birth in 60 women with vertex/non-vertex twin pregnancies. There were no differences in perinatal outcome. The trial was too small to exclude the possibility of clinically meaningful benefits of either approach. There is one additional trial currently ongoing. AUTHORS' CONCLUSIONS: There is a lack of robust evidence to guide clinical advice regarding the method of birth for twin pregnancies. Women should be informed of possible benefits and risks of either approach, including short-term and long-term consequences for both mother and babies. Future research should aim to provide unbiased evidence, including long-term outcomes.
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