A Randomized Trial of Planned Cesarean or Vaginal Delivery for Twin Pregnancy
New England Journal of Medicine, 2013 · paper · Clinical trials
A randomized trial of planned cesarean versus planned vaginal delivery in 2804 twin pregnancies with the first twin head-down. Death or serious neonatal illness occurred in 2.2% versus 1.9%, a difference that was not statistically significant.
Checked: PDF from europepmc.org, fetched 4 Oct 2026. Page numbers are those of that PDF.
2 findings
Reference or label Results p7: "odds ratio for 35 weeks 0 days to 36 weeks 6 days vs. 37 weeks 0 days to 38 weeks 6 days of gestation, 1.83". The stratum is defined everywhere else as 34 weeks 0 days to 36 weeks 6 days.
- p. 7 Results, primary outcome paragraph
odds ratio for 35 weeks 0 days to 36 weeks 6 days vs. 37 weeks 0 days to 38 weeks 6 days of gestation, 1.83
- p. 7 Results, primary outcome paragraph
35 weeks 0 days to 36 weeks 6 days vs. 37 weeks 0
- p. 7 Results, primary outcome paragraph
odds ratio for 35 weeks 0 days to 36 weeks 6 days vs. 37 weeks 0 days to 38 weeks 6 days, 1.83
- p. 3 Methods, randomization strata
34 weeks 0 days to 36 weeks 6 days
Judge's note: The p7 image shows '35 weeks 0 days'. The randomization strata in Methods (p3), the subgroup definitions (p6), the Table 3 rows (p15) and the Table 3 footnote (p16) all use 34 wk 0 d to 36 wk 6 d. No 35-week category is defined anywhere. The stratum is mislabelled.
Second check: another model agreed
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Reference or label In Table 3 the row "Necrotizing enterocolitis — no. (%)§" carries a § mark, but the Table 3 footnotes define only *, † and ‡.
- p. 15 Table 3, row 'Necrotizing enterocolitis'
Necrotizing enterocolitis — no. (%)§
- p. 16 Table 3 footnotes
This outcome was a component of the composite primary outcome.
Judge's note: The p15 image shows § on the NEC row. The p16 footnote block, which is complete, lists only *, † and ‡. NEC is a component of serious neonatal morbidity in Methods (p4), so ‡ was presumably intended.
Second check: another model agreed
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5 minor (typos and the like; most checked by the judge only)
Wording The systemic-infection threshold is "temperature ≥38.5°C on two or more occasions" in Methods (p5) but "a temperature of more than 38.5°C on two or more occasions" in the Table 4 footnote ¶ (p18).
- p. 5 Methods, maternal composite outcome definition
≥38.5°C on two or more occasions at least 24 hours apart
- p. 18 Table 4 footnote ¶
a temperature of more than 38.5°C on two or more occasions
- p. 5 Outcomes, systemic infection
temperature ≥38.5°C on two or more occasions
- p. 18 Table 4 footnote ¶
temperature of more than 38.5°C on two or more occasions
Only the authors can say what is right here.
Judge's note: Both images confirm the wording: an inclusive ≥ in Methods and "more than" in the footnote, for the same definition of maternal infection. The difference is small and probably loose wording, but only the authors can say which threshold was applied.
Second check: another model agreed
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Wording Results p6: "Of the 1393 women randomly assigned to planned cesarean section, 89.9%..." The same page says "A total of 1398 women were randomly assigned to planned cesarean section", and the Table 2 mode-of-delivery denominators are 1392.
- p. 6 Results, paragraph on Table 2
Of the 1393 women randomly assigned to planned cesarean section, 89.9% had a cesarean section
- p. 6 Results, first paragraph
A total of 1398 women were randomly assigned to planned cesarean section
- p. 13 Table 2, mode of delivery
1252/1392 (89.9)
Judge's note: 1393 is the N in the Table 2 column header, i.e. the analysis set, not the number randomized (1398, p6 and Fig. 1). The percentage is correct on either denominator. The wording 'randomly assigned' gives the 1393 as the randomized count; this is a minor wording point.
Second check: another model agreed
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Wording Discussion p8: "we ensured the presence of an experienced obstetrician at delivery". Results p6–7 report one was present for 95.2% of women in the planned-vaginal-delivery group who had a vaginal delivery of the first twin.
- p. 8 Discussion, paragraph 2
we ensured the presence of an experienced obstetrician at delivery
- p. 6 Results, Characteristics of the participants, last paragraph
For 95.2% of the
- p. 7 Results, first lines
an experienced obstetrician, according to our a priori definition, was present at the time of vaginal delivery
Judge's note: Both passages are confirmed on the images. 'Ensured' may describe the protocol requirement, but read beside the 95.2% achieved it slightly overstates compliance. This is a mild wording point.
Second check: another model agreed
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Typo Birth-trauma definition reads "hemorrhage confirmed by mean of ultrasonography"; this should be "by means of".
- p. 4 Methods, Outcomes, definition of birth trauma
hemorrhage confirmed by mean of ultrasonography
- p. 4 Outcomes, birth trauma definition
confirmed by mean of ultrasonography
Judge's note: The page 4 image shows "by mean of". A few lines later on the same page the paper writes "confirmed by means of blood culture" and "by means of cerebrospinal fluid culture". This is a typo.
Second check: none (judge only)
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Typo In Table 4, the row "Other serious or life-threatening illness" shows "1 (0.1)" for planned cesarean but only "1" for planned vaginal delivery, so the percentage is missing.
- p. 17 Table 4, last row, planned vaginal delivery column
1 (0.1)
- p. 17 Table 4, last row
1 (0.1) 1
Judge's note: The p17 image confirms the vaginal-delivery cell shows '1' with no percentage, unlike every other nonzero cell. The value would be 0.1% of 1391.
Second check: none (judge only)