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Objective  Does planned caesarean compared with planned vaginal birth lower the risk of problematic urinary stress, faecal, or flatal incontinence?    Design  Women between 32 0/7  and 38 6/7  weeks of gestation with a twin pregnancy were randomised to planned caesarean or planned vaginal birth.    Setting  The trial took place at 106 centres in 25 countries.    Population  A total of 2305 of the 2804 women enrolled in the study completed questionnaires at 2 years (82.2% follow‐up): 1155 in the planned caesarean group and 1150 in the planned vaginal birth group.    Methods  A structured self‐administered questionnaire completed at 2 years postpartum.    Main outcome measures  The primary maternal outcome of the Twin Birth Study was problematic urinary stress, or fecal, or flatal incontinence at 2 years    Results  Women in the planned caesarean group had lower problematic urinary stress incontinence rates compared with women in the planned vaginal birth group [93/1147 (8.11%) versus 140/1143 (12.25%); odds ratio, 0.63; 95% confidence interval, 0.47–0.83;  P  = 0.001]. Among those with problematic urinary stress incontinence, quality of life (measured using the Incontinence Impact Questionnaire,  IIQ ‐7) was not different for planned caesarean versus planned vaginal birth groups [mean ( SD ): 18.4 (21.0) versus 19.1 (21.5);  P  = 0.82]. There were no differences in problematic faecal or flatal incontinence, or in other maternal outcomes.    Conclusions  Among women with a twin pregnancy and no prior history of urinary stress incontinence, a management strategy of planned caesarean compared with planned vaginal birth reduces the risk of problematic urinary stress incontinence at 2 years postpartum. Our findings show that the prevalence but not the severity of urinary stress incontinence was associated with mode of birth.    Funding  Canadian Institutes of Health Research ( CIHR ) (grant no. MCT‐63164).    Tweetable abstract  For women with twins, planned caesarean compared with planned vaginal birth is associated with decreased prevalence but not severity of urinary stress incontinence at 2 years.

Urinary stress incontinence and other maternal outcomes 2 years after caesarean or vaginal birth for twin pregnancy: a multicentre randomised trial