A randomized trial of planned cesarean or vaginal delivery for twin pregnancy

Barrett, Jon F.R., Hannah, Mary E., Hutton, Eileen K., Willan, Andrew R., Allen, Alexander C., Armson, B. Anthony, Gafni, Amiram, Joseph, K.S., Mason, Dalah, Ohlsson, Arne, Ross, Susan, Sanchez, J. Johanna, Asztalos, Elizabeth J., Farrell, Scott, Hanigsberg, Julia E., Leduc, Line, Okun, Nanette, Bracken, Michael, Crowley, Patricia, Donner, Allan, Duley, Lelia, Ehrenkranz, Richard, Thorpe, Kevin, Castaldi, Jose Luis, Deguer, Carlos, Bertin, Marta Susana, Partida, Yamil, Galimberti, Diana, Messina, Analia, Voto, Liliana S., Voto, Geraldine N., Prieto, María José, Buraschi, Fernanda, Sexer, Héctor, Palmermo, Mario, Montes Varela, Dolores, Franzé, Florencio, Benitez, Patricia, Garcia, Valeria, Savransky, Ricardo, Dunaievsky, Armando, Andina, Elsa, Laterra, Cristina, Susacasa, Sandra, Frailuna, Maria Alejandra, Ramirez Almansa, Silvina, Barrere, Maria Beatriz, García, Horacio, Rivero, Mabel, Gomez, Elena Elizabeth, Schinini, Josefina, Ahlbom, Monica, Aguirre, Jesus Daniel, Morales, Elba Mirta Alicia, Abreo, Griselda Itati, de Sagastizabal, Maria Teresa, Martín, Raquel de Lourdes, Videla, Arturo, Mesas, Walter, Arias, Carlos, Castagnola, Maria Cecilia, Abalos Gorostiaga, Raul, Curioni, Miguel, Mohedano, Maria, Dip, Viviana, Roque, Alicia, Duhalde, Esteban Marcos, Dodd, Jodie, Deussen, Andrea, Crowther, Caroline, Gardener, Glenn, Chaplin, Jackie, Wilkins, Danielle, Mahomed, Kassam, Green, Anne, Baade, Robert, Haran, Mano, Hanafy, Ash, Davis, Greg, Roberts, Lynne, Tucker, Stephen, Duncan, Christine, Watson, David, Lawrence, Annemarie, Laubach, Monika, Breugelmans, Ria, Calderon, Iracema, Martins, Anice, Magalhães, Claudia, Cecatti, Jose Guilherme, Garanhani Surita, Fernanda, Rosado, Luiza, Cortizo Vidal, Augusto, Ribeiro de Souza , Goianice, Maia Filho, Nelson Lorenço, Nunes Santana, Danielly Saranello, Moreira de Sa , Renato Augusto, Marcolino, Luciano, Coelho Marques, Caio, Zanella, Pedro Luis, Milan, Carla, Dalmolin Bollis, Márcia, Steibel, Gustavo, Ayub, Antonio C.K., Moreira, Simone, Barbosa Lima , Antonio Carlos, Scavuzzi, Adriana, Rolland de Souza , Alex Sandro, Barbosa de Moraes Filho, Olimpio, Leita Silva Carvalho, Simone Angélica, Guerios Bornia, Rita, Ribeiro da Silva, Nancy, Spinola, Renata, Marques Lopes, Laudelino, Sass, Nelson, Korkes, Henri, Chalem, Elisa, Morita Yokota, Eliana Junko, Ribeiro de Faria Silveira, Miriam, Wood, Stephen, Miller, Leslie, McLeod, Lynne, Fanning, Cora, Mueller, Valerie, Gregorovich, Sandra, Moore, Elaine, Gratton, Robert, Kennedy, Laura, Scheufler, Peter, Reid, Donna, Klam, Stephanie, Daitchman, Rhona, Farquharson, Duncan, Harrison, Kristy, Kulkarni, Ramesh, Scarfone, Rhonda, Laplante, Joanne, Carson, George, Williams, Suzanne, Rosman, David, Nemtean, Debbie, Olatunbosun, Femi, Pierson, Kathleen, Crane, Joan, Hutchens, Donna, Zaltz, Arthur, Brown, Melissa, Ornstein, Melanie, Visram, Soraya, Bordin, Jennifer, Siurna, Hiliary, Petruskavich, Shelly, Gagnon, Alain, Lee, Jennifer, Fernandez, Ariadna, Kaye, Stephen, Haslauer, Kelly-Ann, Cundiff, Geoffrey, Gomez, Ricardo, Kusanovic, Juan Pedro, Silva Neculman, Karla, Leighton Valenzuela, Luis, Madariaga Leiva, Erika, Romo Cabrera, Juan Guillermo, Molina Ravanal, Mónica, Schiaffino Orrego, Rodrigo, Matijevic, Ratko, Makhlouf, Ahmad, Saber, Osama, Abdelradey, Tarek, Kirss, Fred, Rull, Kristiina, Vaas, Pille, Hopp, Hartmut, Nonnenmacher, Andreas, Michaelis, Silke, Hasbargen, Uwe, Delius, Maria, Antsaklis, Aris, Drakakis, Peter, Major, Tamás, Bartha, Tünde, Salim, Raed, Harel, Linda, Chayen, Benny, Siev, Sima, Hallak, Mordechai, Mei-Dan, Elad, Gonen, Ron, Wolff, Leslie, Sadan, Oscar, Mansour-Schwake, Dalia, Petchinkin, Liana, Hakim, Marwan, Perlitz, Yuri, Ben-Ami, Moshe, Pansky, Samuel, Simms-Stewart, Donnette, Wilson, Monifa, El-Zibdeh, Mazen, AlFaris, Lama, Heres, Marion, Sluis, Aafje, Roumen, Frans J.M.E., Rinkens, Jeannine, Willekes, Christine, Alleman, Sjaak, van Zandvoort, Simon Gordijn, Porath, Martina M., Verhoeven, Corine, Mol, Ben Willem, Radfar, Forough, Khan, Sultana, Preis, Krzysztof, Swiatkowska-Freund, Malgorzata, Krasomski, Grzegorz, Kesiak, Marcin, Krekora, Michael, Zych, Katarzyna, Wilczynski, Jan, Breborowicz, Grzegorz, Dera, Anna, ur Rahman, Ssjjad, Al-Jassim, Amal Abdullah, Stamatian, Florin, Caracostea, Gabriela, Gojnic, Miroslava, Fazlagic, Amira, Perovic, Milan, Vasiljevic, Brankica, Stephanovic, Toma, Gonce, Anna, Herrero Rodriguez, Sara, Massanes, Marta, Carreras Moratonas, Elena, Rodo Rodriguez, Carlota, Arevalo Martinez, Silvia, Llurba, Elisa, Suy Franch, Anna, de la Calle, Maria, Dans, Fernando, Sancha, Marta, Lopez, Sara, Canete Palomo , Maria Luisa, Maldonado del Valle, María Dolores, Rodríguez Martín, María Nieves, Lázaro-Carrasco Delgado, Carolina, Jiménez Fournier, María Carmen, Ojutiku, Dale, Masuku, Maxwell, Goodsell, Kerry, Southam, Donna, Tuffnell, Derek, Germaine, Tracey, Palethorpe, Rebecca, Farrar, Diane, Wright, Janet, Al-Taher, Hamed, Meehan, Helen, Bricker, Leanne, Dower, Michelle, Houghton, Gillian, Pascall, Angela, Longworth, Heather, Sau, Ashis, Thornton, James, Fisher, Joanne, Houda, Mohammed, Simm, Andy, Bugg, George, Deshpande, Ruta, Davis, Yvette, Holloway, Fiona, Bugg, George, Welch, Ross, Hollands, Heidi, Young, Peter, Hinshaw, Kim, Bargh, Amanda, Edmundson, Dawn, Cameron, Helen, Alonso, Justo, Garcia Austt, Alfonso, Ortiz, Alejandra, Burgis, Judith, Brown, Stanette, Gregg, Anthony, Borowski, Kristi, Fleener, Diedre, Deaver, John, Sumersille , Melanie, Aronoff, Christine, Bland, Kimberley, Kontopoulos, Eftichia, Rivero, Yvette, Lovett, Stuart M., Zatinsky, Shana, Diogo, Mary, Coonrod, Dean V., Jimenez, Blanca Flor, Chan, Sunny, Hewson, Sheila A., Hoac, Trinh, Kowal, Christine, Mangoff, Kathryn, Mergler, Sonya, and Shi, Michael (2013) A randomized trial of planned cesarean or vaginal delivery for twin pregnancy. New England Journal of Medicine, 369 (14). pp. 1295-1305.

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Abstract

Background: Twin birth is associated with a higher risk of adverse perinatal outcomes than singleton birth. It is unclear whether planned cesarean section results in a lower risk of adverse outcomes than planned vaginal delivery in twin pregnancy.

Methods: We randomly assigned women between 32 weeks 0 days and 38 weeks 6 days of gestation with twin pregnancy and with the first twin in the cephalic presentation to planned cesarean section or planned vaginal delivery with cesarean only if indicated. Elective delivery was planned between 37 weeks 5 days and 38 weeks 6 days of gestation. The primary outcome was a composite of fetal or neonatal death or serious neonatal morbidity, with the fetus or infant as the unit of analysis for the statistical comparison.

Results: A total of 1398 women (2795 fetuses) were randomly assigned to planned cesarean delivery and 1406 women (2812 fetuses) to planned vaginal delivery. The rate of cesarean delivery was 90.7% in the planned-cesarean-delivery group and 43.8% in the planned-vaginal-delivery group. Women in the planned-cesarean-delivery group delivered earlier than did those in the planned-vaginal-delivery group (mean number of days from randomization to delivery, 12.4 vs. 13.3; P = 0.04). There was no significant difference in the composite primary outcome between the planned-cesarean-delivery group and the planned-vaginal-delivery group (2.2% and 1.9%, respectively; odds ratio with planned cesarean delivery, 1.16; 95% confidence interval, 0.77 to 1.74; P = 0.49).

Conclusion: In twin pregnancy between 32 weeks 0 days and 38 weeks 6 days of gestation, with the first twin in the cephalic presentation, planned cesarean delivery did not significantly decrease or increase the risk of fetal or neonatal death or serious neonatal morbidity, as compared with planned vaginal delivery.

Item ID: 33654
Item Type: Article (Research - C1)
ISSN: 1533-4406
Keywords: twin pregnancy; method of birth; randomized trial; cesarean; vaginal delivery
Funders: Canadian Institutes of Health Research
Date Deposited: 22 Sep 2014 03:03
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1114 Paediatrics and Reproductive Medicine > 111402 Obstetrics and Gynaecology @ 100%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920114 Reproductive System and Disorders @ 100%
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