Format

Send to

Choose Destination
N Engl J Med. 2013 Oct 3;369(14):1295-305. doi: 10.1056/NEJMoa1214939.

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

Collaborators (308)

Barrett JF, Allen AC, Armson BA, Asztalos EV, Farrell S, Gafni A, Hanigsberg JE, Hannah ME, Hutton EK, Joseph KS, Leduc L, Mason D, Ohlsson A, Okun N, Ross S, Sanchez JJ, Willan AR, Allen AC, Armson BA, Asztalos EV, Barrett JF, Bracken M, Crowley P, Donner A, Duley L, Ehrenkranz R, Thorpe K, Castaldi JL, Bertin MS, Partida Y, Galimberti D, Messina A, Voto LS, Voto GN, Prieto MJ, Buraschi F, Sexer H, Palermo M, Varela DM, Savransky R, Dunaievsky A, Andina E, Laterra C, Susacasa S, Frailuna MA, Almansa SR, Barrere MB, García H, Rivero M, Gomez EE, Schinini J, Ahlbom M, Aguirre JD, Martín Rde L, Videla A, Mesas W, Arias C, Castagnola MC, Gorostiaga RA, Curioni M, Mohedano M, Dip V, Roque A, Duhalde EM, Dodd J, Deussen A, Crowther C, Gardener G, Chaplin J, Wilkins D, Mahomed K, Green A, Baade R, Haran M, Hanafy A, Davis G, Roberts L, Tucker S, Duncan C, Watson D, Lawrence A, Laubach M, Breugelmans R, Calderon I, Martins A, Magalhães C, Cecatti JG, Surita FG, Rosado L, Vidal AC, de Souza GR, Maia Filho NL, Santana DS, de Sa RA, Marcolino L, Marques CC, Zanella PL, Milan C, Bollis MD, Steibel G, Ayub AC, Moreira S, Lima AC, Scavuzzi A, de Souza AS, de Moraes Filho OB, Carvalho SA, de Sa RA, Bornia RG, da Silva NR, de Sa RA, Spinola R, Lopes LM, Sass N, Korkes H, Chalem E, Yokota EJ, Silveira MR, Wood S, Miller L, McLeod L, Armson BA, Fanning C, Mueller V, Gregorovich S, Moore E, Gratton R, Kennedy L, Scheufler P, Reid D, Klam S, Daitchman R, Farquharson D, Harrison K, Kulkarni R, Scarfone R, Laplante J, Carson G, Williams S, Rosman D, Nemtean D, Olatunbosun F, Pierson K, Crane J, Hutchens D, Okun N, Zaltz A, Brown M, Ornstein M, Visram S, Bordin J, Siurna H, Petruskavich S, Gagnon A, Lee JM, Fernandez A, Kaye S, Haslauer KA, Cundiff G, Gomez R, Kusanovic JP, Neculman KS, Valenzuela LL, Leiva EM, Cabrera JG, Ravanal MM, Orrego RS, Matijevic R, Makhlouf A, Saber O, Abdelradey T, Kirss F, Rull K, Vaas P, Hopp H, Nonnenmacher A, Michaelis S, Hasbargen U, Delius M, Antsaklis A, Drakakis P, Major T, Bartha T, Salim R, Harel L, Chayen B, Siev S, Hallak M, Mei-Dan E, Gonen R, Wolff L, Sadan O, Mansour-Schwake D, Petchinkin L, Hakim M, Perlitz Y, Ben-Ami M, Pansky S, Simms-Stewart D, Wilson M, El-Zibdeh M, AlFaris L, Heres M, Sluis A, Roumen FJ, Rinkens J, Willekes C, Alleman S, van Zandvoort SG, Porath MM, Verhoeven C, Mol BW, Radfar F, Khan S, Preis K, Swiatkowska-Freund M, Krasomski G, Kesiak M, Krekora M, Zych K, Wilczynski J, Breborowicz G, Dera A, ur Rahman S, Al-Jassim AA, Stamatian F, Caracostea G, Gojnic M, Fazlagic A, Perovic M, Vasiljevic B, Stefanovic T, Gonce A, Rodriguez SH, Massanes M, Moratonas EC, Rodriguez CR, Martinez SA, Llurba E, Franch AS, de la Calle M, Dans F, Sancha M, Lopez S, Palomo ML, del Valle MD, Martín MN, Delgado CL, Fournier MC, Ojutiku D, Masuku M, Goodsell K, Southam D, Tuffnell D, Germaine T, Palethorpe R, Farrar D, Wright J, Al-Taher H, Meehan H, Bricker L, Dower M, Houghton G, Pascall A, Longworth H, Sau A, Thornton J, Fisher J, Houda M, Simm A, Bugg G, Deshpande R, Davis Y, Holloway F, Bugg G, Welch R, Hollands H, Young P, Hinshaw K, Bargh A, Edmundson D, Cameron H, Alonso J, Austt AG, Ortiz A, Burgis J, Brown S, Gregg A, Borowski K, Fleener D, Deaver J, Sumersille M, Aronoff C, Bland K, Kontopoulos E, Rivero Y, Lovett SM, Zatinsky S, Diogo M, Coonrod DV, Jimenez BF, Chan S, Hewson SA, Hoac T, Kowal C, Mangoff K, Mergler S, Shi M.

Author information

1
Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. jon.barrett@sunnybrook.ca

Erratum in

  • N Engl J Med. 2013 Dec 12;369(24):2364.

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; ClinicalTrials.gov number, NCT00187369; Current Controlled Trials number, ISRCTN74420086.).

PMID:
24088091
PMCID:
PMC3954096
DOI:
10.1056/NEJMoa1214939
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Atypon Icon for PubMed Central
Loading ...
Support Center