Clinical indicators associated with the mode of twin delivery: An analysis of 22,712 twin pairs

Simone M.T.A. Goossens*, Chantal W.P.M. Hukkelhoven, Lotte De Vries, Ben Willem Mol, Jan G. Nijhuis, Frans J.M.E. Roumen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)


Objective To identify clinical indicators associated with the planned and actual mode of delivery in women with a twin pregnancy. Study design 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). Conclusion 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.

Original languageEnglish
Pages (from-to)133-140
Number of pages8
JournalEuropean Journal of Obstetrics and Gynecology and Reproductive Biology
Publication statusPublished - 1 Dec 2015


  • Cesarean section
  • Clinical indicator
  • Decision
  • Twin delivery


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