{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T15:22:03Z","timestamp":1759332123689,"version":"3.37.3"},"reference-count":43,"publisher":"Georg Thieme Verlag KG","issue":"11","funder":[{"DOI":"10.13039\/100008250","name":"Feinberg School of Medicine","doi-asserted-by":"crossref","award":["EDW\/Biostatistical Support, Department of Obstetri,Friends of Prentice Grant, Department of Obstetric"],"award-info":[{"award-number":["EDW\/Biostatistical Support, Department of Obstetri,Friends of Prentice Grant, Department of Obstetric"]}],"id":[{"id":"10.13039\/100008250","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"crossref","award":["UL1TR001422"],"award-info":[{"award-number":["UL1TR001422"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:p>\n            Objective\u2003This study aimed to identify patient and provider factors associated with undergoing trial of labor (TOL) among eligible patients with twin gestations.<\/jats:p><jats:p>\n            Study Design\u2003This retrospective cohort study of patients with twin gestations who received care at a large tertiary care center from 2000 to 2016 included individuals with live pregnancies greater than 23 weeks of gestation and cephalic-presenting twin. Patients with a prior uterine scar or contraindication to vaginal delivery were excluded from analyses. Maternal and clinical characteristics were compared among patients who did and did not undergo TOL. Multivariable logistic regression models included characteristics chosen a priori and those with bivariable associations with p\u2009&lt;\u20090.1. Interactions between parity and other significant variables in the primary models were also investigated.<\/jats:p><jats:p>\n            Results\u2003Among 1,888 eligible patients, 80.7% (N\u2009=\u20091,524) underwent TOL. Those undergoing TOL were more likely to be younger, multiparous, and have a maternal\u2013fetal medicine physician as the delivering provider (p\u2009&lt;\u20090.01). Hypertensive disorders of pregnancy were less prevalent among patients undergoing TOL (20.2 vs. 27.8%, p\u2009&lt;\u20090.01). In multivariable analysis, advanced maternal age (adjusted odds ratio [aOR]: 0.55, 95% confidence interval [CI]: 0.40\u20130.74) and nulliparity (aOR: 0.36, 95% CI: 0.25\u20130.52) conferred a lower odds of TOL, while having a maternal\u2013fetal medicine provider (aOR: 2.74, 95% CI: 1.55\u20134.83) was associated with higher odds. Interaction analyses demonstrated no significant interaction effects between parity and other characteristics. Among those undergoing a TOL, 76.0% (1,158\/1,524) had a successful vaginal delivery of both twins, with 48.1% (557\/1,158) having breech extraction of the second twin.<\/jats:p><jats:p>\n            Conclusion\u2003In this cohort of twin gestations with a high frequency of TOL, patient and provider characteristics are associated with attempting vaginal delivery. Variation in provider practices suggests differing skills and comfort with twin vaginal delivery may influence route of delivery decision-making in patients with twins.<\/jats:p><jats:p>\n            Keypoints\n          <\/jats:p>","DOI":"10.1055\/a-2295-3329","type":"journal-article","created":{"date-parts":[[2024,3,26]],"date-time":"2024-03-26T23:58:57Z","timestamp":1711497537000},"page":"1455-1462","source":"Crossref","is-referenced-by-count":1,"title":["Characteristics Associated with Trial of Labor among Patients with Twin Pregnancies"],"prefix":"10.1055","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1562-3070","authenticated-orcid":false,"given":"Danielle T.","family":"Cipres","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachael B.","family":"Cowherd","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois"},{"name":"Division of Gynecology, Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivia H.","family":"Barry","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liqi","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine (Biostatistics), Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lynn M.","family":"Yee","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,4,15]]},"reference":[{"key":"ref1","first-page":"109","article-title":"An evidence-based approach to determining route of delivery for twin gestations","volume":"4","author":"D Christopher","year":"2011","journal-title":"Rev Obstet Gynecol"},{"issue":"7628","key":"ref2","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1136\/bmj.39363.706956.55","article-title":"Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study","volume":"335","author":"J Villar","year":"2007","journal-title":"BMJ"},{"issue":"06","key":"ref3","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1097\/01.AOG.0000219750.79480.84","article-title":"Maternal morbidity associated with multiple repeat cesarean deliveries","volume":"107","author":"R M Silver","year":"2006","journal-title":"Obstet Gynecol"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1097\/GRF.0000000000000105","article-title":"Management of twins: vaginal or cesarean delivery?","volume":"58","author":"C Bibbo","year":"2015","journal-title":"Clin Obstet Gynecol"},{"issue":"14","key":"ref5","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1056\/NEJMoa1214939","article-title":"A randomized trial of planned cesarean or vaginal delivery for twin pregnancy","volume":"369","author":"J F Barrett","year":"2013","journal-title":"N Engl J Med"},{"issue":"05","key":"ref6","doi-asserted-by":"crossref","first-page":"1118","DOI":"10.1097\/01.AOG.0000446856.51061.3e","article-title":"ACOG Practice Bulletin No. 144: multifetal gestations: twin, triplet, and higher-order multifetal pregnancies","volume":"123","author":"ACOG Practice Bulletin No","year":"2014","journal-title":"Obstet Gynecol"},{"issue":"06","key":"ref7","first-page":"1","article-title":"Trends in low-risk cesarean delivery in the United States, 1990-2013","volume":"63","author":"M J Osterman","year":"2014","journal-title":"Natl Vital Stat Rep"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/s12978-015-0043-6","article-title":"What is the optimal rate of caesarean section at population level? 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Panelli","year":"2017","journal-title":"Obstet Gynecol"},{"issue":"01","key":"ref34","doi-asserted-by":"crossref","first-page":"116.e1","DOI":"10.1016\/j.ajog.2015.08.017","article-title":"Fetal presentation and successful twin vaginal delivery","volume":"214","author":"S R Easter","year":"2016","journal-title":"Am J Obstet Gynecol"},{"issue":"06","key":"ref35","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1097\/AOG.0000000000002609","article-title":"A simulator for breech extraction of the second twin","volume":"131","author":"M L Birsner","year":"2018","journal-title":"Obstet Gynecol"},{"key":"ref36","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.ejogrb.2018.12.038","article-title":"Twin vaginal delivery: to maintain skill - simulation is required","volume":"234","author":"J Lepage","year":"2019","journal-title":"Eur J Obstet Gynecol Reprod 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