Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 3, 100023

Trend in Cesarean Delivery Rate Among Twin Pregnancies Over a 20 Years Epoch and the Accompanied Maternal and Perinatal Outcomes


Trend in Cesarean Delivery Rate Among Twin Pregnancies Over a 20 Years Epoch and the Accompanied Maternal and Perinatal Outcomes

Alon Tal et al. Eur J Obstet Gynecol Reprod Biol X.


Objective: To examine the trend of cesarean delivery (CD) rate among twin pregnancies and the trend in maternal and neonatal morbidities within two decades.

Study design: Population-based cohort study, conducted at a single teaching hospital in Israel on data between January 1995 and December 2015. All pregnant women with twin gestation who delivered at a gestational age of 24 weeks or more were included. Data on mode of deliveries, Apgar score <7 at 5 min, cord artery pH < 7.1, early postpartum hemorrhage, blood transfusion, and intrapartum fever for each year were extracted and plotted, and trends were analyzed. CDs performed for one or both twins were divided to laboring, i.e., after a trial of labor, and non-laboring CDs. Data was obtained from the hospital discharge register with ICD-9 codes and crosschecked with the labor medical records. The Cochran-Armitage Trend Test was used to identify trends and correlations.

Results: Of all 88,145 deliveries that took place during this period, 1955 (2.2%) were twins. Of these 53 were ineligible and were excluded. There was a statistically significant trend (increase) in twins birth over time (p = 0.004). CD rate increased significantly from 43.4% in 1995 to 66.0% in 2015 (p = 0.001). This increase was observed only among non-laboring cesareans (p = 0.001). Multivariate logistic regression analysis revealed that maternal and early neonatal morbidities examined did not differ significantly during the study period.

Conclusion: Non-laboring CD rate increased significantly over the past two decades among twin pregnancies. Despite this increase, maternal and early neonatal morbidities did not change.

Keywords: Cesarean delivery rate; Maternal morbidity; Neonatal morbidity; Trend; Twin pregnancies.


Fig. 1
Fig. 1
Trends in cesarean delivery rate among twin pregnancies (1995–2015).

Similar articles

See all similar articles

Cited by 1 article


    1. Charoenboon C., Srisupundit K., Tongsong T. Rise in cesarean section rate over a 20-year period in a public sector hospital in northern Thailand. Arch Gynecol Obstet. 2013;287:47–52. - PMC - PubMed
    1. Miller E.S., Hahn K., Grobman W.A. Society for maternal-fetal medicine health policy committee. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol. 2013;121:789–797. - PubMed
    1. Blanchette H. The rising cesarean delivery rate in America: what are the consequences? Obstet Gynecol. 2011;118:687–690. - PubMed
    1. Lee H.C., Gould J.B., Boscardin W.J., El-Sayed Y.Y., Blumenfeld Y.J. Trends in Cesarean Delivery for Twin Births in the United States: 1995 to 2008. Obstet Gynecol. 2011;118:1095–1101. - PMC - PubMed
    1. Bateni Z.H., Clark S.L., Sangi-Haghpeykar H., Aagaard K.M., Blumenfeld Y.J., Ramin S.M. Trends in the delivery route of twin pregnancies in the United States, 2006-2013. Eur J Obstet Gynecol Reprod Biol. 2016;205:120–126. - PubMed

LinkOut - more resources