Delivery of the term twin

The ever-increasing incidence of twin pregnancies world wide, together with the increasing trend to caesarean delivery, has resulted in intense scrutiny of the most appropriate method of twin delivery. The term twin has an increased risk of twin mortality compared to term singletons and this might be a result of the increase risk of labour and delivery compared to that of singletons. There are three ways to address this from the literature. The first is to compare outcome for the second twin versus the first twin, and to compare these outcomes in those twins delivered vaginally compared to those delivered by lower section caesarean section (LSCS). The second is to compare outcomes for twins delivered vaginally and for those delivered by caesarean section (CS). These data show higher rates of adverse perinatal outcome for the twin at or near term if delivery is vaginal versus CS. The third method is to compare outcomes for twins delivered by planned vaginal birth (VB; actual VB plus emergency CS) versus planned CS. This chapter will review this data thus outline an ongoing randomized controlled trial—the Twin Birth Study.