Randomised controlled trial for twin delivery

doi:10.1136/bmj.326.7386.448

BMJ 2003;326:448 ( 22 February )

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Randomised controlled trial for twin delivery

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EDITOR $---$ The article by Smith et al is a timely retrospective cohort study, in which the possible benefit of planned caesareansection for twins is suggested.¹ A meta-analysis of availablestudies did not show any appreciable difference in neonatal outcomes,but pointed out that available data are mainly level 2, beingbased largely on retrospective cohort studies.²

On the basis of these data and data from the Atlee Nova Scotia perinatal database we have estimated that planned vaginal deliveryof twins at 32 weeks or older carries a risk of perinatal mortalityor serious morbidity of about 4%. To show a reduction in thisto 2% requires 2500 patients (power 80%, alpha error 0.05, twosided). On the basis of our experience with the term breech trialwe believe that such a trial is possible, and with support fromover 175 centres we have submitted such a proposal to the CanadianInstitutes for Health . . . [Full text of this article]

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