Randomised controlled trial for twin deliveryBMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7386.448 (Published 22 February 2003) Cite this as: BMJ 2003;326:448
- University of Toronto, SWCHSC and Maternal Infant Research Unit, 76 Grenville Street, Toronto, Canada M5S 1B6
EDITOR—The article by Smith et al is a timely retrospective cohort study, in which the possible benefit of planned caesarean section for twins is suggested.1 A meta-analysis of available studies did not show any appreciable difference in neonatal outcomes, but pointed out that available data are mainly level 2, being based 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 delivery of twins at 32 weeks or older carries a risk of perinatal mortality or serious morbidity of about 4%. To show a reduction in this to 2% requires 2500 patients (power 80%, alpha error 0.05, two sided). On the basis of our experience with the term breech trial we believe that such a trial is possible, and with support from over 175 centres we have submitted such a proposal to the Canadian Institutes for Health Research. We caution against any radical change in practice without strong evidence from a well designed randomised controlled trial. Any centre that is interested should contact our group at
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