{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T09:31:56Z","timestamp":1764322316894,"version":"3.46.0"},"reference-count":10,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T00:00:00Z","timestamp":1748908800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess whether a trial of labor at term in twin pregnancies, where twin B is at least 250\u2009g heavier than twin A, is associated with increased risk of emergency cesarean section or mixed\u2010mode birth (vaginal delivery of twin A followed by cesarean of twin B). Existing guidelines on this topic are based on heterogeneous cohorts that combine planned cesarean, emergency cesarean, and mixed\u2010mode births, limiting direct conclusions on trial of labor outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective cohort study, we included twin pregnancies referred to a Danish tertiary center from 2007 to 2019. Only those with gestational age\u2009\u2265\u200937\u2009+\u20090\u2009weeks and birth weight discordance &lt;25% were eligible. Among 302 women undergoing trial of labor, 59 had a weight discordance \u2265250\u2009g with twin B as the larger fetus (\u201ctwin B larger\u201d), while 243 formed the control group (\u201ctwins equal\u201d or \u201ctwin A larger\u201d). Primary outcomes were emergency cesarean section and mixed\u2010mode birth. Secondary outcomes included blood loss \u22651000\u2009mL, Apgar score &lt;7 at 5\u2009min, umbilical artery pH &lt;7.1, and neonatal length of stay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The rate of emergency cesarean section was higher in the \u201ctwin B larger\u201d group (29%) compared with controls (19%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.09). Mixed\u2010mode birth occurred in 8.5% of the \u201ctwin B larger\u201d group and 11.5% of controls (risk difference, \u22123.0% [95% CI, \u221211.2% to 5.1%]). No significant differences were observed in secondary neonatal outcomes between groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In twin pregnancies at term where twin B is slightly heavier than twin A, a trial of labor is not associated with a clinically meaningful increase in the risk of mixed\u2010mode birth. While the emergency cesarean section rate was numerically higher, this did not reach statistical significance and should not in itself contraindicate vaginal delivery. Further research with larger sample sizes is warranted to confirm these findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.70246","type":"journal-article","created":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T08:05:14Z","timestamp":1748937914000},"page":"828-833","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Trial of labor when twin B is slightly larger than twin A: A Danish prospective cohort study"],"prefix":"10.1002","volume":"171","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5102-9976","authenticated-orcid":false,"given":"Mohammed R.","family":"Khalil","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Lillebaelt University Hospital  Kolding Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diane Gorm","family":"Malberg\u2010Pedersen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Lillebaelt University Hospital  Kolding Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erling","family":"Andreasen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Lillebaelt University Hospital  Kolding Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S\u00f6ren","family":"M\u00f6ller","sequence":"additional","affiliation":[{"name":"Research Unit OPEN, Department of Clinical Research University of Sothern Denmark and Odense University Hospital  Odense Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camilla Mirian","family":"Hartvigsen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Odense University Hospital  Odense Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niels","family":"Uldbjerg","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Aarhus University Hospital  Aarhus Denmark"},{"name":"Department of Clinical Medicine Aarhus University  Aarhus Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,6,3]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2023.04.002"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13916"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0041-1727228"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajogmf.2022.100767"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.26277"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7210935"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1375\/twin.1.3.123"},{"key":"e_1_2_9_9_1","first-page":"450","article-title":"Birth weight percentiles by gestational age in multiple births. A population\u2010based study of Norwegian twins and triplets","volume":"79","author":"Glinianaia SV","year":"2000","journal-title":"Acta Obstet Gynecol Scand"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1159\/000102055"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.21907"}],"container-title":["International Journal of Gynecology &amp; Obstetrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijgo.70246","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T09:29:35Z","timestamp":1764322175000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/ijgo.70246"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,3]]},"references-count":10,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1002\/ijgo.70246"],"URL":"https:\/\/doi.org\/10.1002\/ijgo.70246","archive":["Portico"],"relation":{},"ISSN":["0020-7292","1879-3479"],"issn-type":[{"type":"print","value":"0020-7292"},{"type":"electronic","value":"1879-3479"}],"subject":[],"published":{"date-parts":[[2025,6,3]]},"assertion":[{"value":"2025-02-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-03","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}