Trends in Caesarean section rates for twin pregnancies: a 20-year cohort study Abstract

Catherine KY WONG,1 Choi Wah KONG,2 William WK TO2
1 Department of Obstetrics and Gynaecology, Pamela Youde Nethersole Eastern Hospital, Hong Kong; 2 Department of Obstetrics and Gynaecology, United Christian Hospital, Hong Kong

Objective: To evaluate trends in Caesarean section (CS) rates for twin pregnancies over 20 years in a regional obstetric unit in Hong Kong.
Methods: Data on twin deliveries between 1998 and 2017 at United Christian Hospital were collected. CS rates were calculated for each calendar year, and data were stratified into four 5-year intervals to determine trends. Twins delivered vaginally or by CS were compared in terms of maternal epidemiological risk factors, pregnancy characteristics, and pregnancy outcome. A logistic regression model was used to determine significant risk factors associated with CS.
Results: From 1998 to 2017, 1083 (1.24%) of 87 480 deliveries were twin deliveries. The total CS rate for twins progressively increased from 58.9% in 1998-2002 to 84.1% in 2013-2017, particularly the CS rate for cephalic + cephalic twins from 41.7% in 1998-2002 to 74.7% in 2013-2017. The CS rate for non-cephalic first twin was close to 100% for all intervals. Logistic regression analysis showed that CS was positively associated with non-cephalic presentation of the first twin (odds ratio [OR]=13.1), previous CS (OR=4.19), and advanced maternal age (OR=1.7) and negatively associated with preterm delivery (OR=0.34), multiparity (OR=0.29), and induction of labour (OR=0.086). For perinatal outcome, CS was significantly associated with higher mean birthweight, lower incidence of adverse perinatal or neonatal outcome but higher risks of postpartum haemorrhage.
Conclusion: A progressive increase in CS rates for twins was observed over the past 20 years, particularly among cephalic-presenting twins, despite the lack of clear evidence on the preferred mode of delivery for such twin pregnancies.

 
Hong Kong J Gynaecol Obstet Midwifery 2019; 19(2):96–102
  Copyright © 2019 by the Obstetrical & Gynaecological Society of Hong Kong
  and the Hong Kong Midwives Association
  Print ISSN:1608-9367
  Online ISSN:2225-904X
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