Zafarmand MH, Goossens SMTA, Tajik P, et al. - A secondary analysis of the Twin Birth Study was performed in order to examine whether planned Cesarean delivery (CD) has differential benefit over planned vaginal delivery (VD) in women with a twin pregnancy and the first twin in cephalic presentation, depending on prespecified baseline maternal and pregnancy characteristics, and/or gestational age (GA) at delivery. The Twin Birth Study involved 2,804 women with a twin pregnancy and the first twin (Twin A) in cephalic presentation between 32 + 0 and 38 + 6 weeks' gestation at 106 centers in 25 countries. Random assignments of these women to either planned CD or planned VD was performed. Of these initially randomized women, researchers herein included 1,391 in each study arm. Findings suggest that depending on GA at delivery and planned mode of delivery, the perinatal outcome may differ in twin pregnancies with the first twin in cephalic presentation. Planned VD appears favorable at 32–37 weeks, while, planned CD might be safer from around 37 weeks onwards. Per finding, there are low absolute risks of adverse perinatal outcomes at term, which must be weighed against the elevated maternal risks linked with planned CD.