**5. Delivery mode: vaginal delivery vs. cesarean section**

The mode of delivery in twin pregnancy depends on multiple factors and is very controversial in the literature. The most important factors to be considered on deciding the delivery mode are the fetus presentation, especially the first twin, fetal weight, weight difference between the fetuses, gestational weight and maternal clinical conditions. Women's parity is also a condition with high influence in mode of delivery in a twin pregnancy, as nulliparous usually result in less success when attempting a vaginal delivery [13].

The decision on either performing an elective cesarean delivery must consider the best neonatal and maternal outcomes, to reduce neonatal morbidity and mortality, maternal complications and preserving the women's reproductive future. The biggest risk in a vaginal delivery is for the second twin, as complications can occur after the delivery of the first twin, including placental abruption, cord prolapse and long delivery intervals [14].

It is important to consider that conditions that would indicate a cesarean section in singleton pregnancies should also be applied in multiple pregnancies.
