Grant: Operating Grant

The number of twins being born is increasing because of the use of assisted reproductive techniques. Twins born at term have a higher risk of death or serious morbidity than singleton babies. Retrospective studies have suggested that caesarean section might be a safer method of delivery for twins, compared to attempting a vaginal birth. However, the only way to determine if this is really true is by carrying out a large prospective randomised controlled trial. Our study enrolled 2800 women at 32-38 weeks gestation (from over 120 centres worldwide) with a twin pregnancy in which the first twin is presenting head first. Women in the study are allocated at random to deliver either by caesarean section or to have a vaginal delivery. The outcome will be assessed for all babies and mothers. For babies, the main outcomes are death or serious morbidity in the first 28 days of life and how well they are developing at 2 years of age. For mothers, outcomes include difficulty with urinary or fecal/flatal incontinence at 3 months and 2 years, satisfaction with the method of delivery and quality of life. The results of this study will be used by obstetricians and other health care providers to counsel women with twin pregnancies about the risks and benefits of the different approaches to delivery, so that women can make an informed choice as to their planned method of delivery.