Twin Birth Study

Question 1

When was the Twin Birth Study published?

Answer 1

2013

Question 2

What were the inclusion criteria for the Twin Birth Study?

Answer 2

32+0 - 38+6/40
Twin pregnancy
First twin in the cephalic presentation

Question 3

What were the exclusion criteria for the Twin Birth Study?

Answer 3

Monoamniotic twins
Fetal reduction at 13 or more weeks
Lethal fetal anomaly
Contraindication to labour or vaginal delivery
Previous participation in the Twin Birth Study

Question 4

What was the rate of Caesarean section in the planned Caesarean delivery group?

Answer 4

90.7%

Question 5

What was the rate of Caesarean section in the planned vaginal delivery group?

Answer 5

43.8%

Question 6

What was the primary outcome in the Twin Birth Study?

Answer 6

Composite of fetal or neonatal death or serious neonatal morbidity

Question 7

Was there a significant difference in the composite primary outcome between the planned CS delivery group and the planned vaginal delivery group?

Answer 7

NO
CS - 2.2%
VD - 1.9%

Question 8

How many women were recruited to the Twin Birth Study?

Answer 8

2804 women

Question 9

In how many centres / countries were women recruited for the Twin Birth Study?

Answer 9

106 centres in 25 countries

Question 10

Was there a difference in the risk of maternal death or serious maternal morbidity between the planned CS delivery and planned vaginal delivery group?

Answer 10

No

This may be partly explained by the high rate of CS in the planned vaginal delivery group

Question 11

For those randomised to CS delivery, when was elective delivery planned?

Answer 11

37+5 - 38+6/40

Question 12

How were women allocated to planned CS delivery or planned vaginal delivery?

Answer 12

Randomised

Question 13

Describe the study protocol:

Answer 13

• Elective delivery planned between 37+5 and 38+6 weeks.
• In planned CS grp, if first twin was delivered vaginally, CS was attempted for 2nd twin if logistically possible.
• In planned vaginal delivery grp, if there was a contraindication to labour or vaginal delivery, CS delivery was undertaken.
• Mothers and infants followed until 28 days postpartum.

Question 14

Describe the strengths of this study:

Answer 14

• Similar baseline characteristics
• Large sample size.
• High rate of follow-up

Question 15

Describe a limitation of this study:

Answer 15

• Findings only generalisable to centres that can provide obstetrical management consistent with study protocol including ability to perform EmCS within 30 mins if needed

Question 16

This study showed no difference in the primary outcome between planned CS and planned vaginal delivery which is in contrast to other studies; why may this be the case?

Answer 16

• Avoided selection bias, ensured presence of experienced obstetrician at delivery and many twins in this trial were born preterm.