Zafarmand MH, Goossens SMTA, Tajik P, et al. - Researchers examined if planned cesarean delivery (CD) may provide a differential benefit to women with a twin pregnancy and a cephalic-presenting first twin; depending on a prespecified list of maternal and pregnancy characteristics (markers), and/or gestational age (GA) at delivery. In this secondary analysis of the Twin Birth Study, they included 2,804 women with a twin pregnancy with a cephalic-presenting first twin between GA of 32⁺⁰ and 38⁺⁶ weeks in 106 centers in 25 countries. The studied markers were maternal age, parity, history of previous CD, use of antenatal corticosteroids, estimated fetal weight (EFW) of twin A, EFW of twin B, > 25% difference in EFW of the twins, presentation of twin B, chorionicity on ultrasound, method of conception, complications of pregnancy, ruptured membranes at randomization and GA at randomization. They identified no association of these markers with differential benefit from a planned CD. Based on GA and planned mode of delivery, differences in neonatal outcomes of twin pregnancies with the first twin in cephalic position may occur. They suggest a planned VD as favorable from 32-37 weeks, while a CD might be safer from around 37 weeks. As low absolute risks at term were observed, they recommend weighing this risk against the increased maternal risks associated with planned CD.