Factors affecting elective cesarean section in women with multiple pregnancy in Caruban, Indonesia [version 1; peer review: 1 approved with reservations]

Background: Caesarean sections have become the most popular method for delivering twin babies because of the safety concerns associated with a natural birth. This study aims to identify the maternal characteristics and obstetric parameters that serve as risk factors influencing caesarean delivery in twin pregnancies by comparing women delivering via caesarean section and vaginal birth. Methods: A retrospective chart review design was used to analyse 47 women with multiple pregnancies from the medical records at a primary referral hospital in East Java, Indonesia. Women delivering vaginally were then compared with women who underwent a caesarean section to identify any differences between the groups. Results: More women delivered by caesarean section than by vaginal birth. In this study, women were more likely to undergo a caesarean section if they had a previous history of undergoing a caesarean section or if there were no foetal malpresentations during their pregnancy. There was a significant difference in maternal age between groups. We found that foetal malpresentation did not significantly increase the likelihood of caesarean delivery in women with multiple pregnancies. Conclusions: The percentage of multiple pregnancies delivered via caesarean section is quite high. Similar to previous studies, we identified a few factors including foetal malpresentation and labour augmentation that did not significantly increase the risk of caesarean delivery. However, we suggest that there is more than one reason responsible for the increase in caesarean sections in multiple pregnancies.