Elective birth at 37 weeks of gestation versus standard care for women with an uncomplicated twin pregnancy at term: the Twins Timing of Birth Randomised Trial.
OBJECTIVE
To evaluate whether for women with an uncomplicated twin pregnancy, elective birth at 37 weeks of gestation was associated with reduced risk of death or serious outcomes for babies, without increasing harm.


METHODS
Randomised controlled trial.


METHODS
Maternity hospitals across Australia, New Zealand and Italy.


METHODS
A total of 235 women with an uncomplicated twin pregnancy at 36(+6) weeks of gestation, with no contraindication to continuing their pregnancy.


METHODS
Using a computer-generated, central telephone randomisation service, 235 women were randomised to Elective Birth (birth at 37 weeks; n=116) or Standard Care (continued expectant management, with birth planned from 38 weeks; n=119). Outcome assessors were masked to treatment allocation.


METHODS
A composite of serious adverse outcome for the infant.


RESULTS
For women with an uncomplicated twin pregnancy, elective birth at 37 weeks of gestation was associated with a significant reduction in risk of serious adverse outcome for the infant (Elective Birth 11/232 [4.7%] versus Standard Care 29/238 [12.2%]; risk ratio [RR] 0.39; 95% CI 0.20-0.75; P=0.005), reflecting a reduction in birthweight less than the third centile using singleton gestational age-specific charts (Elective Birth 7/232 [3.0%] versus Standard Care 24/238 [10.1%]; RR 0.30; 95% CI 0.13-0.67; P=0.004). In a post hoc analysis using twin gestational age-specific charts, there was evidence of a trend towards a reduction in the primary composite of serious adverse infant outcome (Elective Birth Group 4/232 [1.7%] versus Standard Care Group 12/238 [5.0%]; RR 0.34; 95% CI 0.11 to 1.05; P=0.06).


CONCLUSIONS
The findings of our study support recommendations for women with an uncomplicated twin pregnancy to birth at 37 weeks of gestation.
Australian Research Centre for Health of Women and Babies (ARCH), Robinson Institute, The University of Adelaide, Adelaide, SA, Australia. jodie.dodd@adelaide.edu.au
J M
JM
Dodd
C A
CA
Crowther
R R
RR
Haslam
J S
JS
Robinson
D000328:Adult; D001720:Birth Injuries / Q000401:mortality; D005260:Female; D005313:Fetal Death; D005865:Gestational Age; D006801:Humans; D007751:Labor, Induced / Q000379:methods* / Q000401:mortality; D007744:Obstetric Labor Complications / Q000209:etiology; D054238:Perinatal Mortality; D011247:Pregnancy; D011256:Pregnancy Outcome; D059285:Pregnancy, Twin; D011295:Prenatal Care / Q000379:methods*; D013997:Time Factors; D055815:Young Adult