title: Racial disparities in outcomes of twin pregnancies: elective cesarean or trial of labor?
abstract: OBJECTIVE
  The objective of the study was to determine the relationships between maternal race and obstetric outcomes in twin gestations by planned mode of delivery.
  
  
  METHODS
  We performed a secondary analysis of the Consortium on Safe Labor data. Patients with twin gestations in vertex-vertex presentation greater than 32 weeks' gestational age were grouped according to race. Demographic information and neonatal and maternal outcomes were analyzed according to planned mode of delivery: elective cesarean or trial of labor (with subsequent vaginal delivery, unplanned cesarean, or combined delivery). The primary outcome was unplanned cesarean. Secondary outcomes included maternal and neonatal outcomes.
  
  
  RESULTS
  One thousand nine vertex-vertex twin pregnancies were identified. There were no significant differences across ethnicities in the rate of unplanned cesarean delivery, which occurred in 233 of patients undergoing trial of labor (27%). Elective cesarean occurred in 151 patients (15%). African American women were less likely to have an elective cesarean compared with whites (odds ratio, 0.5; 95% confidence interval, 0.3-0.8), and Asian women were more likely to have an elective cesarean compared with whites (odds ratio, 2.0; 95% confidence interval, 1.2-3.4. Combined delivery occurred in 67 patients (8%) and did not differ among the groups. Subgroup analysis did not reveal any significant differences in neonatal outcomes. Adverse maternal outcomes were rare across ethnicities.
  
  
  CONCLUSIONS
  Unplanned cesarean delivery rates are similar in twin pregnancies, regardless of race. Maternal and neonatal outcomes in twin gestations are similar across ethnicities, regardless of mode of delivery.
authors.affiliation: Department of Obstetrics and Gynecology, MedStar Georgetown University Hospital, Washington, DC; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY. Electronic address: dd2573@cumc.columbia.edu.
authors.forename: Daphnie
authors.initials: D
authors.lastname: Drassinower
authors.affiliation: Department of Obstetrics and Gynecology, MedStar Georgetown University Hospital, Washington, DC; Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, DC; Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Julia
authors.initials: J
authors.lastname: Timofeev
authors.affiliation: Department of Biostatistics and Epidemiology, MedStar Health Research Institute, Georgetown-Howard Universities Center for Clinical and Translational Science, Hyattsville, MD.
authors.forename: Chun-Chih
authors.initials: CC
authors.lastname: Huang
authors.affiliation: Department of Obstetrics and Gynecology, MedStar Georgetown University Hospital, Washington, DC.
authors.forename: Helain J
authors.initials: HJ
authors.lastname: Landy
mesh_terms: D000328:Adult; D001034:Apgar Score; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007902:Length of Stay / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D006473:Postpartum Hemorrhage / Q000208:ethnology; D011247:Pregnancy; D059285:Pregnancy, Twin / Q000706:statistics & numerical data*; D047928:Premature Birth / Q000208:ethnology; D044469:Racial Groups / Q000706:statistics & numerical data*; D014219:Trial of Labor; D014481:United States / Q000453:epidemiology
keywords: elective cesarean; mode of delivery; trial of labor; twins