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.