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CME Credit Offered
CME Credit Offered
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Recording available 2/16-5/2
Recording available 2/16-5/2
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Abstract Award
Abstract Award
Foundation Awardee
Foundation Awardee

Poster Session 4

Category: Epidemiology

Poster Session 4

(1238) Trends in Twin Mode of Delivery Over Time

Thursday, February 12, 2026
3:30 PM - 5:00 PM  
Objective:
About 3% of all births in the United States are twin gestations. This number has been gradually rising largely due to an increase in the use of assisted reproductive technology. In 2008, approximately 75% of twins were delivered by cesarean birth. The objective of this study was to identify trends in the mode of delivery of twin gestations in a large US-based cohort from 2008 to 2020.

Study Design:
We performed a retrospective cohort study of twin pregnancies that delivered between 36 and 39 weeks in California between 2008 and 2020. Pregnancies were then stratified by parity, history of cesarean birth and presentation of the second twin. We graphically examined trends in mode of delivery and logistic regression analyses was used to determine odds of cesarean with increase in birth year.

Results:
56,562 twin pregnancies were identified. The cesarean birth rate across all time periods was 83.7% for all twins, 73.1% for vertex-vertex presentation and 88.7% for vertex-breech presentation. With increase in birth year, odds of cesarean decreased in nulliparous (OR=0.98; 95% CI: 0.97-0.99) and multiparous without prior cesarean (OR=0.97; 95% CI: 0.96-0.98) (Figure 1). When stratified by presentation of the second twin this trend was significant, except for nulliparous pregnancies with vertex-breech presentation (Figure 2).

Conclusion:
The twin cesarean birth rate in California is decreasing over time. This trend was strongest in vertex-vertex presenting twins, but also demonstrated in vertex-breech presentation. The most notable decrease was in multiparous patients with no prior cesarean and vertex-vertex presentation which went from 59.1% in 2008 to 42.2% in 2020. Ongoing efforts to decrease cesarean birth rates are possible contributors to this finding and emphasize the importance of prenatal counseling on mode of delivery for twin gestations.