1. Introduction
Compared to singleton pregnancies, twin pregnancies are at a higher risk
for an adverse perinatal outcome[1]-[3].
Hence, the optimal mode of delivery is a particularly contentious issue.
A long-lasting debate keeps the controversy going; while some authors
suggest that vaginal delivery is a safe option for uncomplicated twin
pregnancies[4]-[6], other investigators
recommend planned caesarean section (PCS) in order to avoid intrapartum
complications, especially those derived from breech
extraction[7]-[9].
Due to their idiosyncrasy, the dilemma in monochorionic diamniotic
(MCDA) twins is even greater, as vascular anastomoses between fetal
circulations can result in acute and dramatic hemodynamic intrapartum
changes[10]-[12]. But even in uneventful
monochorionic pregnancies, likelihood of adverse perinatal outcomes is
higher compared with singletons and dichorionic twin
pregnancies[10],[13]-[14].
Although chorionicity has a significant influence on perinatal outcomes,
most studies dealing with the mode of delivery in twins do not stratify
this topic accordingly5,15. Furthermore, published
studies regarding the mode of delivery in MCDA pregnancies do not
consider essential outcome issues as induction of labor when attempting
vaginal delivery or neurodevelopment[16]-[23].
Also, in most reports, the results are based on multicenter studies or
national databases analysis, which makes them difficult to extrapolate,
as there are no common and homogeneous obstetric policies. Neonatal
criteria for defining morbidity are different, and in many cases do not
cover all the main complications of MCDA pregnancies.
The purpose of this study was to investigate perinatal outcomes and
2-year-neurodevelopment for moderately to late preterm and early term
MCDA twins with respect to the mode of birth, as well as to assess the
safety of the induction of labor at a major tertiary center in Spain.