Background: Twins complicate approximately 2-3% of all births. Twin fetuses that are >2500g at birth are at higher risk of death and neonatal morbidity than singletons of the same birth weight. In addition, the second twin is at higher risk of death and/or serious neonatal morbidity compared with twin A if delivery is vaginal but not if delivery is by caesarean section (CS). There has been one randomized controlled trial (RCT) of planned CS versus planned vaginal birth (VB) for twins: the sample size was too small to answer the question of the better approach to delivery. A Cochrane review has recommended that a larger RCT be undertaken.
Primary Research Question: For twin pregnancies of 32-38 weeks gestation, where twin A is in cephalic presentation, does a policy of planned caesarean section decrease the likelihood of perinatal or neonatal mortality or serious neonatal morbidity, during the first 28 days after birth, compared to a policy of planned vaginal birth?
Conclusion: Recruitment was completed in April 2011. 2804 women were enrolled from 106 centres representing 25 countries around the world. The final analysis of the primary data was undertaken and the results are to be disseminated in late 2012. TBS will answer a question of importance to women, clinicians and policy makers.
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