Maternal and infant outcomes of planned mode of delivery in twin pregnancies: A systematic review and meta-analysis.

INTRODUCTION

The optimal mode of delivery for twins has been debated for decades. The objective of this study is to compare maternal and perinatal outcomes between planned cesarean birth and planned vaginal delivery in twin pregnancies.

MATERIAL AND

METHODS

We conducted searches across MedLine, CINAHL, Cochrane CENTRAL, Web of Science, Scopus, and Embase, from database inception to June 13, 2025, for studies that compared planned vaginal delivery with planned cesarean birth regarding maternal and/or neonatal outcomes in twin gestations. Random-effects models were used to estimate pooled odds ratios (OR) with 95% confidence intervals (CI), and heterogeneity was assessed using the I2 statistic. The Downs and Black scale was used to assess study quality and risk of bias.

RESULTS

Among 11 207 publications, 33 studies met the inclusion criteria. Planned cesarean versus vaginal delivery showed no significant differences in neonatal death (OR 0.99, 95% CI: 0.58-1.67), Apgar score <7 at 5 min (OR 0.74, 95% CI: 0.51-1.08), low umbilical artery pH (OR 0.56, 95% CI: 0.30-1.06), or maternal death (OR 0.68, 95% CI: 0.11-4.31). The analysis of composite adverse outcomes (16 studies) showed a slight advantage for planned cesarean (OR 0.96, 95% CI: 0.94-0.99). Planned vaginal delivery showed lower rates of periventricular leukomalacia (OR 3.14, 95% CI: 1.45-6.83) and maternal wound complications (OR 1.86, 95% CI: 1.25-2.76).

CONCLUSIONS

Planned cesarean delivery in twin pregnancies shows a small trend toward improved neonatal outcomes but is associated with higher maternal wound complications. Mortality and most individual outcomes were similar between groups. Individualized decisions should guide the choice of delivery mode.