{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T15:09:00Z","timestamp":1784300940552,"version":"3.55.0"},"reference-count":44,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T00:00:00Z","timestamp":1772841600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T00:00:00Z","timestamp":1772841600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Despite the increasing trend in cesarean section rates in multiple pregnancies, vaginal delivery in twin pregnancies appears both possible and safe.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective multicenter study compared outcomes before and after the implementation of a vaginal twin intervention in two Italian hospitals. In January 2021 in Pescara and in July 2022 in Florence, physicians with expertise in twin and breech vaginal birth started working in each center, and clinicians and midwives started quarterly training in these skills. The study period was divided into two equal time intervals and lasted 8\u2009years in Pescara and 5\u2009years in Florence. Providers were also surveyed about how the intervention affected their confidence, skill, and knowledge levels. Diamniotic pregnancies with two viable twins, \u226534\u2009weeks of gestation, and cephalic presentation of the first twin were included. A total of 278 women were evaluated, split into pre\u2010intervention (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009131) and post\u2010intervention (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009147) periods.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Vaginal birth rates increased from 9.2% to 40.8% overall, with no negative effect on maternal or neonatal outcomes. Participating providers felt more skilled, knowledgeable, and confident and agreed that the training improved vaginal birth rates as well as their vaginal breech skills.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In settings with a high background cesarean section rate, a rapid increase in the vaginal birth rate of twins is possible without adversely affecting maternal or neonatal outcomes, via either staff\u2010wide training or specialist teams. Simulation and skills training can improve provider confidence, knowledge, and skill levels as well as impact clinical practice in the labor ward.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.70947","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T13:25:56Z","timestamp":1772976356000},"page":"1025-1035","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating the effect of two different training interventions on improving vaginal twin birth rates and provider confidence and knowledge levels: A pre\u2010 and post\u2010intervention study"],"prefix":"10.1002","volume":"174","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4976-2957","authenticated-orcid":false,"given":"Claudio","family":"Celentano","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Santo Spirito Hospital, Affiliated University G. d'Annunzio Chieti\u2010Pescara  Pescara Italy"},{"name":"EASC, Santo Spirito Hospital  Pescara Italy"},{"name":"Breech Without Borders  Crawfordsville Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Matarrelli","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology SS. Annunziata Hospital, University G. d'Annunzio Chieti\u2010Pescara  Chieti Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Rosati","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Santo Spirito Hospital, Affiliated University G. d'Annunzio Chieti\u2010Pescara  Pescara Italy"},{"name":"EASC, Santo Spirito Hospital  Pescara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Mercaldi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Santo Spirito Hospital, Affiliated University G. d'Annunzio Chieti\u2010Pescara  Pescara Italy"},{"name":"Department of Obstetrics and Gynecology SS. Annunziata Hospital, University G. d'Annunzio Chieti\u2010Pescara  Chieti Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Meloni","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology S. Giovanni di Dio Hospital  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"Molino","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology S. Giovanni di Dio Hospital  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurora","family":"Padelli","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology S. Giovanni di Dio Hospital  Florence Italy"},{"name":"Department of Obstetrics and Gynecology Careggi University Hospital  Florence Italy"},{"name":"Department of Maternal\u2010Infancy Careggi University Hospital  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiorella","family":"Conti","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Santo Spirito Hospital, Affiliated University G. d'Annunzio Chieti\u2010Pescara  Pescara Italy"},{"name":"EASC, Santo Spirito Hospital  Pescara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Prefumo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology IRCCS Istituto Giannina Gaslini  Genoa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rixa","family":"Freeze","sequence":"additional","affiliation":[{"name":"Breech Without Borders  Crawfordsville Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,7]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0038-1668117"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002853"},{"key":"e_1_2_12_4_1","first-page":"1","article-title":"Is twin childbearing on the decline? Twin births in the United States, 2014\u20102018","volume":"351","author":"Martin JA","year":"2019","journal-title":"NCHS Data Brief"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13284"},{"key":"e_1_2_12_6_1","unstructured":"Ministero della Salute.Certificato di assistenza al parto (CeDAP). Analisi dell'evento nascita \u2010 Anno 2023. Accessed November 1 2025.https:\/\/www.salute.gov.it\/new\/sites\/default\/files\/imported\/C_17_pubblicazioni_3524_allegato.pdf"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2005.00631.x"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0412.2011.01356.x"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1214939"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD006553.pub3"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002048"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/01443615.2017.1393402"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.70074"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0029-7844(99)00474-3"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgyn.2011.10.005"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003785"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogoh.2022.102377"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000004397"},{"key":"e_1_2_12_19_1","unstructured":"National Institute for Health and Care Excellence.Evidence review for mode of birth: [F] Twin and Triplet Pregnancy [NICE Guideline No. NG137].2019.https:\/\/www.nice.org.uk\/guidance\/ng137"},{"key":"e_1_2_12_20_1","unstructured":"National Institute for Health and Care Excellence.Twin and Triplet Pregnancy [NICE Guideline No. NG137].2019. Reviewed 2024.https:\/\/www.nice.org.uk\/guidance\/ng137"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3182318651"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2016.08.031"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0251078"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.23736\/S2724-606X.24.05614-8"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.15773"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001598"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2018.12.038"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2020.05.020"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.55840"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000446856.51061.3e"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-023-07040-6"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1396815"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.23750\/abm.v93i5.13179"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2009.09.015"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181d9f4cd"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogc.2017.06.029"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare9020170"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogoh.2022.102434"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.1080\/13668250903093125"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002680"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002609"},{"key":"e_1_2_12_42_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002424"},{"key":"e_1_2_12_43_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11517-023-02864-5"},{"key":"e_1_2_12_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2022.11.015"},{"key":"e_1_2_12_45_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.70103"}],"container-title":["International Journal of Gynecology &amp; Obstetrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijgo.70947","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ijgo.70947","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijgo.70947","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T14:53:28Z","timestamp":1784300008000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/ijgo.70947"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,7]]},"references-count":44,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1002\/ijgo.70947"],"URL":"https:\/\/doi.org\/10.1002\/ijgo.70947","archive":["Portico"],"relation":{},"ISSN":["0020-7292","1879-3479"],"issn-type":[{"value":"0020-7292","type":"print"},{"value":"1879-3479","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,7]]},"assertion":[{"value":"2025-11-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}