The effect of mode of delivery and gestational age on neonatal outcome of the non-cephalic- presenting second twin

OBJECTIVE: Our purpose was to compare the neonatal morbidity of the non-cephalic- and cephalicpresenting second twin in terms of mode of delivery and gestational age. STUDY DESIGN: A retrospective cohort study of 422 sets of twins with a cephalic-presenting first twin was performed. RESULTS: The non-cephalic-presenting second twin was less likely to be delivered vaginally than the cephalic second twin, odds ratio 0.5 (95% CI 0.3-0.8). There were no significant differences in low Apgar scores at 5 minutes and admission to the neonatal intensive care unit for non-cephalic-presenting compared with cephalic-presenting second twins, adjusted odds ratio 1.1 (95 % CI 0.5-2.2) and 1.4 (0.8-2.6). Delivery by caesarean section was associated with increased admission to the neonatal intensive care unit for cephalic second twins, adjusted odds ratio 3.8 (1.2-12.7). Neonatal morbidity after vaginal delivery was similar for non-cephalic-presenting and cephalic-presenting second twins, particularly at lower gestational ages (24-31 weeks, Apgar score at 5 minutes <7, adjusted odds ratio 0.8 [0.1-11.3]). CONCLUSION: Vaginal delivery for the non-cephalic-presenting second twin appears to be a reasonable management option, particularly at early gestational ages.     

Cesarean delivery for twins: a systematic review and meta-analysis

OBJECTIVE: We undertook a systematic review and meta-analysis to determine whether a policy of planned cesarean section or vaginal delivery is better for twins. STUDY DESIGN: We searched MEDLINE and EMBASE from 1980 through May 2001 using combinations of the following terms: twin, delivery, cesarean section, vaginal birth, birth weight, and gestational age. Studies that compared planned cesarean section to planned vaginal birth for babies weighing at least 1500 g or reaching at least 32 weeks' gestation were included. We computed pooled odds ratios for perinatal or neonatal mortality, low 5-minute Apgar score, neonatal morbidity, and maternal morbidity. The infant was the unit of statistical analysis. Results were considered statistically significant if the 95% CI did not encompass 1.0. RESULTS: We retrieved 67 articles, 63 of which were excluded. Four studies with a total of 1932 infants were included in the analysis. A low 5-minute Apgar score occurred less frequently in twins delivered by planned cesarean section (odds ratio, 0.47; 95% CI, 0.26-0.88) principally because of a reduction among twins if twin A was in breech position (odds ratio, 0.33; 95% CI, 0.17-0.65). Twins delivered by planned cesarean section spent significantly longer in the hospital (mean difference, 4.01 days; 95% CI, 0.73-7.28 days). There were no significant differences in perinatal or neonatal mortality, neonatal morbidity, or maternal morbidity. CONCLUSION: Planned cesarean section may decrease the risk of a low 5-minute Apgar score, particularly if twin A is breech. Otherwise, there is no evidence to support planned cesarean section for twins.     

Neonatal death and morbidity in vertex-nonvertex second twins according to mode of delivery and birth weight

OBJECTIVE: The purpose of this study was to assess the risk of neonatal death and morbidity in vertex-nonvertex second twins according to the mode of delivery and birth weight. STUDY DESIGN: Data from a retrospective cohort study that was based on all twin births in the United States (1995-1997) were used. RESULTS: A total of 15,185 vertex-nonvertex second twins were classified into 3 groups: (1) both twins were delivered by cesarean delivery (37.7%), (2) both twins were delivered vaginally (46.8%), and (3) the second twin was delivered by cesarean delivery after vaginal delivery of the first twin (15.5%). The risk of asphyxia-related neonatal deaths and morbidity was increased in the group in which both twins were delivered vaginally and the group in which both twins were delivered by cesarean delivery. The increase in neonatal death in the group in which both twins were delivered vaginally was stronger in the birth weight of < 1500 g. In contrast, in the group in which both twins were delivered vaginally and the group in which the second twin was delivered by cesarean delivery after the first twin was delivered vaginally, the increase in neonatal morbidity was greater in the group in which the birth weight was 1500 to 4000 g. CONCLUSION: The risk of neonatal death and morbidity in second-born twins is higher in the group in which both twins were delivered vaginally and the group in which the second twin was delivered by cesarean delivery after the first twin was delivered vaginally compared with the group in which both twins were delivered by cesarean delivery.     

Trial of vaginal delivery for twins – is it safe? a single center experience

Purpose: This study assessed our hospital protocol of vaginal delivery for twins and evaluated whether trial of vaginal delivery (unless contraindicated) was as safe as elective cesarean. Risk factors leading to failed trial of labor (TOL) were characterized to improve our ability to advise patients and select cases for TOL.

Methods: This retrospective, cohort study included women >32 weeks gestation, with twin A in cephalic presentation and no contraindications for vaginal delivery. Controls were women with twin pregnancy and planned cesarean delivery (PCD). Maternal and neonatal morbidity between TOL and PCD were compared. TOL group was subcategorized by vaginal or cesarean delivery to characterize pre-labor risk factors for failed TOL.

Results: Of the 411 twins, 215 had TOL and 196 had PCD. Among TOL, 196/215 (91%) delivered vaginally. TOL was more likely to have spontaneous pregnancy, pregnancy complications and tended to deliver earlier. More TOL had postpartum hemorrhage (p?Conclusions: The results support the contemporary practice of TOL for twins at term when the first is in cephalic presentation with no other contraindications.     

The Maternal-Fetal Medicine Unit cesarean registry: trial of labor with a twin gestation

OBJECTIVE: The purpose of this study was to identify the success rates and risks in women with a twin pregnancy who attempt a trial of labor after cesarean delivery. STUDY DESIGN: Cases were identified in the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network's Cesarean Registry with a woman with a twin pregnancy who had had at least 1 previous cesarean delivery. RESULTS: During the study period (1999-2002), 412 women fulfilled the study criteria, and 226 women had elective repeat cesarean delivery. Of the 186 women (45.1% of total) who attempted a trial of labor, 120 women were delivered successfully (success rate, 64.5%), and 66 women (35.5%) had a failed trial of labor. Thirty of the failed trials of labor involved a vaginal delivery for twin A and cesarean delivery for twin B. Women who attempted a trial of labor with twins had no increased risk of transfusion, endometritis, intensive care unit admissions, or uterine rupture when compared with elective repeat cesarean delivery. Fetal and neonatal complications were uncommon in either group at>or=34 weeks of gestation. CONCLUSION: A trial of labor with twins after previous cesarean delivery does not appear to increase maternal morbidity. Perinatal morbidity is uncommon at>or=34 weeks of gestation.     

Neonatal morbidity in second twin according to gestational age at birth and mode of delivery

OBJECTIVE: This study was undertaken to assess the risk of neonatal morbidity in the second twins. STUDY DESIGN: We carried out a cohort study of 128,219 live born second twins in the United States, 1995 through 1997. The study subjects were divided into 3 groups: second twins delivered by cesarean section after vaginal delivery of the first twin (V-C), both twins delivered vaginally (V-V), and both twins delivered by cesarean section (C-C). RESULTS: The rates of low 5-minute Apgar score, mechanical ventilation, and seizure were higher in the V-C group (8.27%, 13.39%, and 0.31%) than in the V-V (3.07%, 7.51%, and 0.08%) and the C-C (2.66%, 8.53%, and 0.06%) groups. The V-C associated increase in risk remained after adjustment for confounding factors and was more evident at term than preterm. CONCLUSION: The risk of neonatal morbidity is increased in second twins who had a cesarean section after vaginal delivery of the first twin, especially at term.     

Attempted vaginal versus planned cesarean delivery in 195 breech first twin pregnancies

BACKGROUND: To compare neonatal and maternal outcomes for breech first twins according to whether vaginal or cesarean delivery was planned and to verify that in appropriate selected cases, attempted vaginal delivery is a reasonable choice. METHODS: A retrospective study of all twin pregnancies with the first twin in breech position and gestational age at least 35 weeks at birth at two French university hospital centers from January 1994 through December 2000. The primary outcome was a combined indicator of neonatal mortality and severe morbidity, as defined by one or more of the following: death before discharge, admission to neonatal intensive care unit, 5-minute Apgar score <7, cord blood pH <7.10, or birth trauma. RESULTS: Cesarean delivery was planned for 71 (36.4%) patients, and attempted vaginal delivery for 124 (63.6%), 59 (47.6%) of whom were delivered vaginally and 65 (52.4%) by cesarean during labor. Neither the combined negative outcome indicator nor neonatal mortality differed significantly for either twin or either group. There were no significant differences in maternal mortality or morbidity between the two groups. The frequency of deep vein thrombophlebitis or pulmonary embolism requiring anticoagulant therapy was significantly higher in the planned cesarean group [3/71 (4.2%) versus 0/124; p=0.047]. CONCLUSION: When appropriate criteria are used to decide mode of delivery, a careful intrapartum protocol is followed, and an experienced obstetrician, midwife, and anesthesiologist are in attendance, attempted vaginal delivery is a reasonable option for first twins in breech position.     

Randomized management of the second nonvertex twin: vaginal delivery or cesarean section

Sixty twin deliveries after the thirty-fifth gestational week with vertex-breech and vertex-transverse presentations were managed according to a randomization protocol. Thirty-three parturient women (21 vertex-breech and 12 vertex-transverse presentations) were allocated for vaginal delivery and 27 for cesarean section (18 vertex-breech and nine vertex-transverse). Six pairs of twins in the vaginal delivery group were delivered in a different mode than requested by the protocol (two women underwent cesarean section; in four cases the second twin spontaneously changed to vertex presentation). There were no significant differences between 1- and 5-minute Apgar scores and incidence of neonatal morbidity between the second-born twins in both study groups. Firstborn twins had higher 1-minute Apgar scores than the second-born infants irrespective of route of delivery (p less than 0.05). No case of birth trauma or neonatal death was recorded. Maternal febrile morbidity was significantly higher in the cesarean section group than in the vaginal delivery group (40.7% versus 11.1%, p less than 0.05). These results suggest that in twins with vertex-breech or vertex-transverse presentations after the thirty-fifth week of gestational age the neonatal outcome of the second twin was not significantly influenced by the route of delivery.     

Neonatal and maternal outcomes in twin gestations > or =32 weeks according to the planned mode of delivery

OBJECTIVE: To determine a possible relationship between neonatal and maternal outcomes in twin gestations and the planned mode of delivery. STUDY DESIGN: A single-centre retrospective cohort study in twins > or =32 weeks of gestational age was performed. Baseline characteristics, and neonatal and maternal outcomes were documented according to the planned mode of delivery: a planned caesarean section or a planned vaginal birth. Statistical analysis was performed using chi-square test. Fisher exact test was used in case correction was needed. RESULTS: During the study period (1999-2002), 164 twins > or =32 weeks were enrolled in the study. In 29 women (17.7%) an elective caesarean section was performed. The remaining 135 twins (82.3%) were allowed to start a vaginal delivery. An emergency or an urgent secondary caesarean section for both twins was performed in 26 women, and in 2 women for twin B only. One twin B baby died during planned vaginal delivery. No significant differences in perinatal mortality and serious neonatal morbidity were found between both groups (10.3% versus 9.6%). Neonatal outcomes in twins A were significantly better than in twins B (2.4% versus 7.3%), independent of the planned mode of delivery. Serious maternal morbidity was not significantly different between both groups (13.8% versus 19.3%), although 2 women in the elective caesarean section group needed a relaparotomy for haemorrhage. CONCLUSION: Our results do not support an elective caesarean section for twin gestations > or =32 weeks. The success rate of vaginal delivery in the planned vaginal birth group was nearly 80%.     

Vaginal birth after cesarean delivery in the twin gestation

The pregnancy outcomes of 56 women with a twin gestation and a prior cesarean birth were analyzed to determine whether a trial of labor was a reasonable consideration. Of these patients, 31 (55%) underwent an elective repeat cesarean delivery and 25 (45%) attempted vaginal delivery. Of those who attempted vaginal delivery, 18 (72%) were vaginally delivered of both infants. The dehiscence rate among women with twin pregnancies who attempted a trial of labor was 4% compared with 2% in women with singleton pregnancies. There were no significant differences in maternal or neonatal morbidity or mortality rates in trial of labor versus no trial of labor groups. We conclude in this limited population that a trial of labor in a twin gestation after a previous cesarean delivery appears to be a reasonable consideration. The usual safeguards for attempted vaginal delivery in the twin gestation should be followed.     

Cesarean delivery for the second twin

OBJECTIVE: To examine maternal and infant outcomes after a vaginal delivery of twin A and a cesarean delivery of twin B, and to identify whether the second twin experienced increased short-term morbidity as part of a combined route of delivery. METHODS: Between January 1, 1999, and December 31, 2000, a prospective cohort study of all cesarean deliveries was conducted at 13 university centers. This secondary analysis was limited to women with twin gestations who experienced labor and underwent cesarean delivery. We compared outcomes of the second twin in women who had vaginal delivery of the first twin and a cesarean delivery of the second twin to those who had cesarean delivery of both twins. RESULTS: One thousand twenty-eight twin pregnancies experienced labor and underwent cesarean delivery; 179 (17%) had a combined vaginal/cesarean delivery. Gestational age at delivery was 34.6 weeks in both groups (P=.97). The rupture of membranes to delivery interval was longer in the combined group (3.2 compared with 2.3 hours, P<.001). Endometritis and culture-proven sepsis in the second twin were more common in the combined group, respectively (n=24, odds ratio 1.6, 95% confidence interval, 1.0-2.7; n=15, odds ratio 1.8, 95% confidence interval, 1.0-3.4). These differences were not significant after logistic regression analysis. There were no statistically significant differences in an arterial cord pH of less than 7.0, Apgar score less than or equal to 3 at 5 minutes, seizures, grade III or IV intraventricular hemorrhage, hypoxic ischemic encephalopathy, or neonatal death. CONCLUSION: Combined twin delivery may be associated with endometritis and neonatal sepsis when compared with a twin delivery where both are delivered by cesarean in twin pregnancies experiencing labor. More serious neonatal sequelae, including hypoxic ischemic encephalopathy and death, were not affected by the route of delivery of the second twin.     

Long-term outcomes of twins based on the intended mode of delivery*

Objective: Recent studies have shown that for twin pregnancies with a cephalic presenting first twin, planned vaginal delivery is not associated with adverse short-term neonatal outcomes, as compared to planned cesarean delivery. Our objective was to compare long-term outcomes in twins, based on planned mode of delivery.

Study design: This was a prospective, observational cohort of twin pregnancies delivered by a single MFM practice. All the patients with a twin pregnancy >34 weeks delivered from 2005–2014 were surveyed regarding pediatric outcomes at or after 2 years of life. The survey was mail-based, with phone follow-up for nonresponses or for clarification of answers. Using chi-square, Student’s t-tests, and regression analysis we compared outcomes between women who planned a vaginal (with active management of the second stage) versus cesarean delivery. The main outcome measures were: (1) a composite of major adverse outcomes (death, cerebral palsy, necrotizing enterocolitis, chronic renal, heart, or lung disease); (2) a composite of minor adverse outcomes (learning disability, speech therapy, occupational therapy, physical therapy).

Results: Five hundred and thirty-two women met inclusion criteria and 354 (66.5%) responded. 178 (50.3%) women planned to have a cesarean delivery (100% of whom had a cesarean delivery) and 176 (49.7%) women planned to have a vaginal delivery (83% of whom had a vaginal delivery). The average age of the children at the time of the survey was 5.9 years. There were no differences in any pediatric outcomes between the two groups. After controlling for maternal age, IVF, obesity, and preeclampsia, the planned mode of delivery was not associated with a composite of major adverse outcomes (aOR 0.673, 95% CI 0.228, 1.985), nor a composite of minor adverse outcomes (aOR 0.767, 95% CI 0.496, 1.188).

Conclusions: Planned vaginal delivery with active management of the second stage of labor in twin pregnancies >34 weeks is not associated with adverse childhood outcomes.     

Neonatal mortality and morbidity in vertex-vertex second twins according to mode of delivery and birth weight.

OBJECTIVE: To assess the risk of neonatal mortality and morbidity in vertex-vertex second twins according to mode of delivery and birth weight. STUDY DESIGN: Data from a historical cohort study based on a twin registry in the US (1995-1997) were used. Multivariate logistic regression was used to control for maternal age, race, marital status, cigarette smoking during pregnancy, parity, medical complications, gestational age, and other confounders. RESULTS: A total of 86 041 vertex-vertex second twins were classified into two groups: second twins delivered by cesarean section after cesarean delivery of first twin (C-C) (43.0%), second twins whose co-twins delivered vaginally (V-X) (57.0%). In infants of birth weight>or=2500 g group, the risks of noncongenital anomaly-related death (adjusted odds ratio (aOR): 4.64, 95% confidence interval (95% CI): 1.90, 13.92), low Apgar score (aOR: 2.39, 95% CI: 1.43, 4.14), and ventilation use (aOR: 1.31, 95% CI: 1.18, 1.47) were higher in the V-X group compared with the C-C group. No asphyxia-related neonatal deaths occurred in C-C group, whereas the incidence of this death was 0.04% in the V-X group. CONCLUSION: The risks of neonatal mortality and morbidity are increased in vertex-vertex second twins with birth weight>or=2500 g whose co-twins delivered vaginally compared with second twins delivered by cesarean section after cesarean delivery of first twin.     

Neonatal mortality in second twin according to cause of death, gestational age, and mode of delivery

OBJECTIVE: The purpose of this study was to assess the risk of neonatal death in the second twin. STUDY DESIGN: We carried out a retrospective cohort study of 128,219 live born second twins in the United States for the years 1995 through 1997. The study subjects were divided into 3 groups: second twins who were delivered by cesarean delivery after vaginal delivery of the first twin (group 1), both twins delivered vaginally (group 2), and both twins delivered by cesarean delivery (group 3). RESULTS: The risk of asphyxia-related neonatal deaths was increased in groups 1 and 2; the increased risk in group 1 was stronger in term births than in preterm births. CONCLUSION: The risk of neonatal deaths, especially for term infants with asphyxia-related deaths, is increased for the second twins who are delivered by cesarean delivery after vaginal delivery of the first twins.     

Delayed-interval delivery in twin pregnancies: report of three cases and literature review

Introduction: Delayed delivery is sometimes performed in selected multifetal pregnancies when the first twin birth occurs inevitably. The aim of this procedure is to improve the prognosis and decrease the morbidity and mortality of the second twin. We report three cases of delayed-interval delivery of dichorionic–diamniotic twin pregnancies assisted in our center between 2015 and 2017. After the first twin delivery, the second twin was left in utero and the patient received tocolytic therapy and antibiotics. Cervical cerclage was not performed.

Results: Our patients were admitted between 21?+?3 and 23?+?6 weeks of gestation. We achieved an average interval delivery of 6.33 d. Four out of six twins did not survive the delayed interval procedure. The average stay of the first and second twins that were admitted to the neonatal intensive care unit (NICU) was of 72?d (28–116) and 39.5?d (12–67), respectively. The first twin birth was vaginal in all cases, while the second twin delivery was performed by cesarean section in two out of our three patients. Our neonatal results are not favorable, probably due to the extreme prematurity.

Conclusions: Delayed delivery of the second twin before 28 weeks of gestation can be an alternative for the obstetrician since it could prolong the pregnancy until a gestational age which confers a better prognosis and a better perinatal outcome for the second twin.     

Mode d’accouchement des grossesses gémellaires

The assessment of optimal delivery for twin gestations is complex due to the relatively high frequency of obstetrical complications and to the heterogeneity of delivery management in these conditions. The extern validity of the Anglo-Saxon studies is limited in particular because delivery management of the second twin (approach of external cephalic version) differs from the French one (approach of internal version and/or total breech extraction) in cases of non-vertex second twin. Anglo-Saxon studies suggest that a planned vaginal delivery is associated to an increased risk of neonatal morbidity for second twin compared to first twin at term, in particular in cases of combined vaginal-cesarean birth. To reduce the interval twin-to-twin delivery interval and the number of combined vaginal-cesarean births, in our opinion, one must stop to perform external cephalic version and recommend a routinely active management for the second non-vertex twin delivery. With this active management, there is no evidence to support planned cesarean section for twins. Nevertheless, active management requires training as internal version might be difficult to perform, and therefore it is essential to pursue to teach junior obstetrician these obstetric maneuvers. There is limited role for trial of labor after cesarean delivery in twin gestation with a policy of active management.     

Occurrence and predictors of cesarean delivery for the second twin after vaginal delivery of the first twin

OBJECTIVE: To estimate the occurrence and to assess clinical predictors of emergent cesarean delivery in the second twin after vaginal delivery of the first twin. METHODS: We conducted a population-based cohort study, using the 1995-1997 linked mother/infant twin data from the United States. The adjusted risk ratios and population attributable risks of clinical predictors of emergent cesarean delivery in second twins were estimated for the overall study sample and for those born at less than 36 or 36 weeks or more of gestation. RESULTS: Among the 61,845 second twin births with the first twin delivered vaginally, 5,842 (9.45%) were delivered by cesarean. The cesarean delivery rate was increased in infants born to mothers with medical or labor and delivery complications. Breech and other malpresentations were the most important predictors of emergent cesarean delivery for the second twin (population attributable risk 33.2%; 95% confidence interval 31.8%, 34.6%). Operative vaginal delivery of the first twin was associated with a decreased risk of cesarean delivery for the second twin. Prediction of emergent cesarean for the second twin by clinical factors was stronger in term births than preterm births. CONCLUSION: In the general population, the cesarean delivery rate for the second twin after vaginal delivery of the first twin is approximately 9.5%. With the presence of breech and other malpresentations, the need for emergent cesarean delivery of the second twin after vaginal delivery of the first twin is increased by 4-fold. LEVEL OF EVIDENCE: II-2     

Mode of delivery for breech presentation in grandmultiparous women.

OBJECTIVES: To compare maternal and neonatal outcomes of planned vaginal delivery vs. elective cesarean delivery for breech presentation at term. METHODS: Retrospective study of term breech deliveries from January 1997 through December 2000. A group of 128 women for whom vaginal delivery was planned was compared with a group of 122 women who had an elective cesarean delivery with regard to neonatal mortality and morbidity (birth trauma, birth asphyxia, hyperbilirubinemia, and duration of stay in the neonatal intensive care unit) and maternal morbidity (infections, hemorrhage, hysterectomy, deep venous thrombosis, and pulmonary embolism). RESULTS: There was no difference in neonatal mortality and morbidity between the two groups (13.0% vs. 9.4%). There were fewer maternal complications in the planned vaginal group than in the elective cesarean group (5.5% vs. 18%; P<0.01). In the planned vaginal delivery group 70% of multiparas and 85% of grandmultiparas were delivered vaginally compared with 50% of nulliparas. CONCLUSIONS: In breech presentations at term vaginal delivery can be achieved in 85% of grandmultiparas without significant neonatal morbidity. Elective cesarean section is associated with increased maternal morbidity compared with planned vaginal delivery.     

Management of Nonvertex Second Twin

Objectives

The objective of the current study is to compare outcomes of twin pregnancies with attempted labor and active second-stage management with twin pregnancies delivered by planned cesarean delivery.

Material and Methods

Two hundred and eighty-three patients with twin pregnancy meeting the inclusion criteria were reviewed. They were followed for success of ECV and/or IPV in planned vaginal group and abdominal mode of delivery. Fetal outcome was assessed by APGAR score of both twins as well as NICU admission, if needed.

Results

Out of 283 patients, 116 patients (40.9 %) had planned cesarean section, and 167 patients (59.01 %) had planned vaginal delivery. Out of 167 patients, 148 patients (88.6 %) had a vagi nal delivery of both twins. ECV was successful in 36 patients (25.3 %), and IPV was successful in 102 (95.3 %). IPV failed in five patients (4.6 %), and hence resorted to emergency cesarean section. There was no significant difference in the rates of twin B having a 5-min Apgar score lower than 7 or an arterial cord pH below 7.20 in both the groups. Among the patients in the planned vaginal delivery group, the cesarean delivery rate was 8.3 %, out of which combined vaginal—cesarean delivery rate was 4.6 %.

Conclusion

Active second-stage management is associated with neonatal outcomes similar to those with planned cesarean delivery and a low risk of combined vaginal—cesarean delivery.     

Mode of delivery and neonatal outcome in uncomplicated monochorionic twin pregnancies

Objective: The association between of mode of delivery and perinatal morbidity in monochorionic (MC) twins is not clear. Thus there is no agreement regarding the optimal mode of delivery of MC twins. The aim of this study is to determine the impact of the mode of delivery on neonatal outcome of uncomplicated MC twins in a tertiary center with a strict policy of delivering MC twins by 37 weeks’ gestation. Methods: Retrospective analysis of all uncomplicated MC twin deliveries at a tertiary referral hospital during a 5-year period. Complicated MC pregnancies (fetal death, selective reduction, twin to twin transfusion syndrome, fetal growth restriction of one or both twins or major fetal anomalies) were excluded. Induction of labor or planned caesarean sections of uncomplicated MC pregnancies was conducted between 35 and 37 weeks of gestation. Neonatal outcomes of MC twins were compared according to the mode of delivery. Moreover, mode of delivery was compared with a control group of 1934 dichorionic (DC) twin pregnancies delivered during the same period. Results: The rate of Caesarean section was 63.4% in uncomplicated MC/DA twins pregnancies and this was similar to our rate in DC twins (61%, p = 0.65). Multivariate analysis revealed that adverse neonatal outcome was significantly associated with gestational age at delivery, neonatal birth weight discordance and male gender but not with the intended or actual mode of delivery. Conclusion: Delivering MC twin pregnancies by 37 weeks’ gestation is associated with similar rate of vaginal deliveries compared with DC twin pregnancies. The neonatal outcome was not affected by the mode of delivery, and therefore vaginal delivery seems safe in MC twins.