Trial reportThe New England journal of medicine2013
A randomized trial of planned cesarean or vaginal delivery for twin pregnancy.
Trial report in The New England journal of medicine, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to 2 registered trials, which are not on this map. Cited by 104 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The Twin Birth Study: A Multicentre Randomised Controlled Trial Comparing Planned Vaginal Birth to Elective Caesarean Section of Twins More Than or Equal to 32 Weeks Gestation
National Prospective and Comparative Study on the Mode of Delivery of Twins
Who cites it
104 citing papers in PubMed, 5 syntheses or guidelines pooled it, 467 citations in OpenAlex.
- External cephalic version in nonvertex second twin-Success rate, mode of delivery, and safety: A systematic review.Acta obstetricia et gynecologica Scandinavica · 2025Pooled it
- Timing of Delivery for Twins With Growth Discordance and Growth Restriction: An Individual Participant Data Meta-analysis.Obstetrics and gynecology · 2022Pooled it
- What is the safest mode of delivery for extremely preterm cephalic/non-cephalic twin pairs? A systematic review and meta-analyses.BMC pregnancy and childbirth · 2017Pooled it
- Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis.BMJ (Clinical research ed.) · 2016Pooled it
- Planned caesarean section for women with a twin pregnancy.The Cochrane database of systematic reviews · 2015Pooled it
- Norepinephrine versus phenylephrine infusion for preventing postspinal hypotension during cesarean section for twin pregnancy: a double-blinded randomized controlled clinical trial.BMC anesthesiology · 2022Trial
- Planned Cesarean or planned vaginal delivery for twins: secondary analysis of randomized controlled trial.Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology · 2021Trial
- Trial
- Cesarean delivery or induction of labor in pre-labor twin gestations: a secondary analysis of the twin birth study.BMC pregnancy and childbirth · 2020Trial
- Urinary stress incontinence and other maternal outcomes 2 years after caesarean or vaginal birth for twin pregnancy: a multicentre randomised trial.BJOG : an international journal of obstetrics and gynaecology · 2018Trial
- The effect of induction method in twin pregnancies: a secondary analysis for the twin birth study.BMC pregnancy and childbirth · 2017Trial
- Maternal outcomes at 3 months after planned caesarean section versus planned vaginal birth for twin pregnancies in the Twin Birth Study: a randomised controlled trial.BJOG : an international journal of obstetrics and gynaecology · 2015Trial
- Induction of labor versus cesarean section after 36 + 0 weeks in twin pregnancy: A review of maternal and neonatal outcomes.Acta obstetricia et gynecologica Scandinavica · 2026Article
- Maternal Intensive Care Unit Utilization by Mode of Delivery in the United States: A Retrospective Cohort Study.Anesthesia and analgesia · 2026Article
- Evaluating the effect of two different training interventions on improving vaginal twin birth rates and provider confidence and knowledge levels: A pre- and post-intervention study.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026Observational
- Early versus late amniotomy during twin labor.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026Article
- Anesthetic approaches for malpresentation and multiple gestation.Current opinion in anaesthesiology · 2026Review
- Viability of Successful Vaginal Delivery in Triplet Pregnancies: A Retrospective Cohort Study Over 20 Years.Birth (Berkeley, Calif.) · 2026Article
- Predicting cesarean delivery in twin pregnancies undergoing trial of labor: a multicenter cohort study.BMC pregnancy and childbirth · 2026Article
- Risk factors for combined vaginal-cesarean delivery in the vertex-vertex twins: a case-control study.Archives of gynecology and obstetrics · 2026Article
44 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
- Commented on by
- Commented on by
- Commented on by
- Commented on by
- Commented on by
- Commented on by
- Erratum issued
Authors and funding
14 authors at 8 institutions in 2 countries.
Funding
Abstract
backgroundTwin 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.
methodsWe 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.
resultsA 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).
conclusionsIn 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.).
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.