{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T12:30:07Z","timestamp":1764333007907},"reference-count":16,"publisher":"Georg Thieme Verlag KG","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:p>\n            Objective\u2003The aim of the study is to examine clinical and demographic factors associated with trial of labor (TOL) among women with twin gestations eligible for a vaginal delivery.<\/jats:p><jats:p>\n            Study Design\u2003This was a population-based cohort study of women giving birth to twin gestations in the United States (2012\u20132014). Inclusion criteria for the analysis included live births greater than 23 weeks' gestation and a cephalic presenting twin. Women with prior cesarean delivery were excluded. Women were categorized by whether they underwent a TOL. Clinical and demographic characteristics associated with TOL status were evaluated using multivariable logistic regression analyses. Secondary analyses with stratification by parity and by second twin presentation were performed.<\/jats:p><jats:p>\n            Results\u2003Of 90,000 women eligible for inclusion, a minority (39.3%) underwent TOL. Women who had a greater gestational age at delivery were more likely to have a TOL. In contrast, several demographic factors were associated with decreased likelihood of TOL, including maternal age &gt;35 years and identifying as Hispanic or Asian compared with non-Hispanic White. No differences in odds of TOL were observed for women who were identified as non-Hispanic Black versus non-Hispanic White, nor were other demographic factors such as marital status, insurance status, or educational attainment associated with undergoing TOL. Clinical factors associated with decreased odds of TOL included nulliparity, obesity, and hypertensive disorders of pregnancy. Results did not substantively change when stratified by parity or second twin presentation, nor did findings differ in the subgroup who delivered at 32 weeks of gestation or greater.<\/jats:p><jats:p>\n            Conclusion\u2003In this large population of women with twins who were eligible for a TOL, a minority of individuals attempted a vaginal delivery. Demographic and clinical factors such as older maternal age, Asian or Hispanic racial or ethnic identification, nulliparity, and obesity are associated with decreased odds of undergoing TOL.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/s-0041-1727228","type":"journal-article","created":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T23:41:49Z","timestamp":1618962109000},"page":"214-221","source":"Crossref","is-referenced-by-count":2,"title":["Disparities in Trial of Labor among Women with Twin Gestations in the United States"],"prefix":"10.1055","volume":"40","author":[{"given":"Gina N.","family":"Mo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yvonne W.","family":"Cheng","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, California Pacific Medical Center, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron B.","family":"Caughey","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Oregon Health & Science University, Portland, Oregon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lynn M.","family":"Yee","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2021,4,20]]},"reference":[{"issue":"02","key":"ref1","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":"ref2","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 FR Barrett","year":"2013","journal-title":"N Engl J Med"},{"issue":"04","key":"ref3","first-page":"e131","article-title":"Practice Bulletin No. 169: multifetal gestations: twin, triplet, and higher-order multifetal pregnancies","volume":"128","author":"Committee on Practice Bulletins\u2014Obstetrics","year":"2016","journal-title":"Obstet Gynecol"},{"issue":"12","key":"ref4","first-page":"CD006553","article-title":"Planned caesarean section for women with a twin pregnancy","author":"G J Hofmeyr","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"ref5","volume-title":"Births: Final Data for 2017","author":"J A Martin","year":"2018"},{"issue":"05","key":"ref6","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1097\/AOG.0b013e3182318651","article-title":"Trends in cesarean delivery for twin births in the United States: 1995-2008","volume":"118","author":"H C Lee","year":"2011","journal-title":"Obstet Gynecol"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.ejogrb.2016.08.031","article-title":"Trends in the delivery route of twin pregnancies in the United States, 2006-2013","volume":"205","author":"Z H Bateni","year":"2016","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"03","key":"ref8","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.ajog.2014.01.026","article-title":"Safe prevention of the primary cesarean delivery","volume":"210","author":"A B Caughey","year":"2014","journal-title":"Am J Obstet 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responsibility model of obstetric ethics and caesarean delivery","volume":"27","author":"F A Chervenak","year":"2013","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"issue":"191","key":"ref20","first-page":"1","article-title":"Vaginal birth after cesarean: new insights","author":"J M Guise","year":"2010","journal-title":"Evid Rep Technol Assess (Full Rep)"}],"container-title":["American Journal of 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