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Type: Journal article
Title: A randomized trial of planned cesarean or vaginal delivery for twin pregnancy
Author: Barrett, J.F.
Hannah, M.E.
Hutton, E.K.
Willan, A.R.
Allen, A.C.
Armson, B.A.
Gafni, A.
Joseph, K.
Mason, D.
Ohlsson, A.
Ross, S.
Sanchez, J.J.
Asztalos, E.V.
Citation: New England Journal of Medicine, 2013; 369(14):1295-1305
Publisher: Massachusetts Medical Society
Issue Date: 2013
ISSN: 0028-4793
Statement of
Jon F.R. Barrett, Mary E. Hannah, Eileen K. Hutton, Andrew R. Willan, Alexander C. Allen, B. Anthony Armson … et al. (for the Twin Birth Study Collaborative Group)
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). Conclusions: 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. (Funded by the Canadian Institutes of Health Research; number, NCT00187369; Current Controlled Trials number, ISRCTN74420086.)
Keywords: Twin Birth Study Collaborative Group; Humans; Fetal Death; Infant, Newborn, Diseases; Pregnancy Outcome; Delivery, Obstetric; Cesarean Section; Gestational Age; Pregnancy; Time Factors; Adult; Infant, Newborn; Female; Perinatal Mortality; Pregnancy, Twin
Rights: © 2013 Massachusetts Medical Society. All rights reserved.
RMID: 0030032035
DOI: 10.1056/NEJMoa1214939
Appears in Collections:Obstetrics and Gynaecology publications

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