It is often believed that when having a twin pregnancy, the delivery will not be vaginally, but this is not the case. Having a twin pregnancy does not by itself mean having a cesarean delivery.
There are several factors that are taken into account when deciding how the delivery will be, and these are determined by the type of gestation (bicorial -as a baby in its placenta- or monochorial -they share the placenta-), the gestation time, the estimated weight of the babies, how they are positioned in the womb, and the experience of the obstetric team.
As we mentioned in a previous article, there are different types of cesarean section depending on the moment in which it is decided to perform it:
- Elective caesarean section : a scheduled intervention in pregnant women with maternal or fetal pathology that contraindicates or advises against vaginal delivery.
- Cesarean section in labor or appeal : once labor has started, situations may arise that require this intervention.
- Urgent cesarean section : During the delivery phase, unexpected situations of extreme urgency may occur that require urgent surgical intervention.
In this case, we will discuss in which situations an elective cesarean section is performed in a multiple pregnancy, that is, we already know in advance that the delivery will be by cesarean section.
Twin Pregnancy: Vaginal Delivery or Cesarean Section?
The SEGO (Spanish Society of Gynecology and Obstetrics), indicates in its clinical practice guide the following recommendations on twin birth, and in which cases to perform an elective cesarean section:
- Attempt vaginal delivery if both twins are in cephalic (head) presentation, unless there are contraindications.
- If the first twin is in the cephalic position and the second in another presentation and the gestation is less than 32 weeks and the estimated weight is less than 1,500 g: perform elective caesarean section .
- If the first twin is in the cephalic position and the second in another presentation and the gestation is greater than or equal to 32 weeks and the estimated weight is equal to or greater than 1,500 g: vaginal route , always taking into account the experience of the obstetric team.
- If the first twin is in non-cephalic presentation: elective caesarean section .
It also takes into account other considerations:
- Before a vaginal delivery, the risk of cesarean section of the second twin, regardless of its fetal statics, is 5-10%.
- In cases of cephalic / non-cephalic presentation in fetuses with an estimated weight between 500-1,500 g, there is no scientific evidence in favor of elective caesarean section or vaginal delivery.
- In cases where the first twin is breech (breech) and the estimated weight is> 1,500 g, there is no evidence that elective caesarean section is superior to vaginal delivery. However, the recommendation is to perform a cesarean section . This recommendation is based on: 1) the possibility of locking of the fetal heads and 2) the results of the multicenter study on the management of breech delivery in single pregnancies.
These are the recommendations of the SEGO, but you should know that then each autonomous community and each hospital has its own protocols , so if you are expecting twins, it is important that you inform yourself beforehand about the protocol of your hospital and prepare your birth plan.
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