What is the safest mode of delivery for extremely preterm cephalic/non-cephalic twin pairs? A systematic review and meta-analyses

Table 3 Outcomes in a systematic review/meta-analyses on the safest mode of delivery for extremely preterm cephalic/non-cephalic twin pairs

Outcome	GA category (weeks)	Number of studies		CS (n/N)	VD (n/N)	OR (95% CI) for CS	I² (%)	GRADE Quality of the evidence*
Neonatal death or Severe Brain Injury in survivors	24⁺⁰–27⁺⁶	2	First twin (cephalic)	1/6	4/8	OR 0.35 (0.00–92.61)	76	Very Low
			Second twin (non-cephalic)	3/7	2/6	OR 1.69 (0.04–72.81)	55
			Both twins	4/13	6/14	OR 0.83 (0.05–13.43)	56
Neonatal death	24⁺⁰–27⁺⁶	2	First twin (cephalic)	0/7	2/10	OR 0.36 (0.03–4.40)	0	Very low
			Second twin (non-cephalic)	2/8	2/9	OR 1.31 (0.02–79.60)	66
			Both twins	2/15	4/19	OR 0.73 (0.10–5.46)	26
Severe Brain Injury in survivors	24⁺⁰–27⁺⁶	2	First twin (cephalic)	1/6	2/6	OR 0.59 (0.00–154.35)	74	Very low
			Second twin (non-cephalic)	1/5	0/4	OR 1.00 (0.02–40.28)	N/A	Very low
			Both twins	2/11	2/10	OR 0.76 (0.03–17.34)	48
Respiratory distress syndrome (RDS)	25⁺⁰–27⁺⁶	2	First twin (cephalic)	13/14	15/15	OR 0.23 (0.01–6.25)	N/A	Very low
			Second twin (non-cephalic)	13/14	13/15	OR 1.60 (0.12–20.99)	N/A
			Both twins	26/28	28/30	OR 0.77 (0.10–5.87)	0

GA gestational age, CS caesarean section, VD vaginal delivery, n number of cases within exposure group, N total number in exposure group, OR odds ratio, CI confidence interval, Severe Brain Injury defined as intraventricular hemorrhage grade ≥ 3 or periventricular leukomalacia, N/A not applicable. *Based on the Grading of Recommendations Assessment, Development and Evaluation quality of evidence assessment (GRADE) approach

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