Delivering Twins Safely: Which Way Is Best?

Determining the safest delivery mode for twins has been controversial, particularly when the second twin is not in cephalic presentation. Previous retrospective cohort studies have suggested that planned cesarean delivery is associated with fewer adverse perinatal outcomes, fueling support for this approach. Now, Canadian investigators have conducted a multicenter, international study in which they randomized 1398 women with twin pregnancies (gestation, 32–39 weeks; first twin in cephalic presentation) to planned vaginal delivery or planned cesarean delivery. The primary outcome was a composite of fetal and neonatal mortality and serious neonatal morbidity; maternal outcomes also were assessed.

Among women in the planned-cesarean group, 90% …