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Am J Perinatol 2020; 37(13): 1324-1334
DOI: 10.1055/s-0039-1693695
Original Article

Induction of Labor versus Cesarean Delivery in Twin Pregnancies

Kelly B. Zafman
1   Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
,
Andrei Rebarber
1   Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
2   Maternal Fetal Medicine Associates, PLLC, New York, New York
,
Stephanie Melka
1   Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
2   Maternal Fetal Medicine Associates, PLLC, New York, New York
,
Mariam Naqvi
1   Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
2   Maternal Fetal Medicine Associates, PLLC, New York, New York
,
Nathan S. Fox
1   Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
2   Maternal Fetal Medicine Associates, PLLC, New York, New York
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Abstract

Objective This study was aimed to compare maternal and neonatal outcomes between women with twin pregnancies who underwent induction of labor with those women who had planned Cesarean delivery (CD).

Study Design This is a retrospective cohort study of women with twin pregnancies ≥ 24 weeks with an indication for delivery but not in labor. Two groups were examined, women who underwent induction and women who underwent planned CD. Maternal and neonatal outcomes were compared between groups both for deliveries at gestational age ≥ 37 weeks and < 37 weeks.

Results A total of 453 patients were included. Overall, 212 (46.8%) women underwent induction and 241 (53.2%) underwent planned CD. Women who underwent induction of labor had a high rate of VD, both in the term and preterm groups (69.8 and 73.6%, respectively). Women who underwent induction of labor had reduced maternal length of stay, neonatal length of stay, and blood loss, without any increase in adverse outcomes. Neonatal ventilation of either twin delivered < 37 weeks was higher in the CD compared with induction group (27.5 vs. 9.4%, p < 0.01), but this was not significant on adjusted odds ratio analysis (aOR = 0.71, 95% CI: 0.19–2.66).

Conclusion Labor induction in twin gestations have improved maternal outcomes and similar neonatal outcomes compared with planned CD.

Keywords

twin delivery - induction of labor - elective cesarean


Publication History

Received: 08 February 2019

Accepted: 07 June 2019

Article published online:
25 July 2019

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

  • References

  • 1 Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: final data for 2016. 2018; 67 (01) 1-55
    PubMedSearch in Google Scholar
  • 2 Bateni ZH, Clark SL, Sangi-Haghpeykar H. et al. Trends in the delivery route of twin pregnancies in the United States, 2006–2013. Eur J Obstet Gynecol Reprod Biol 2016; 205: 120-126
    CrossrefPubMedSearch in Google Scholar
  • 3 Barrett JFR, Hannah ME, Hutton EK. et al. A randomized trial of planned cesarean or vaginal delivery for twin pregnancy. N Engl J Med 2013; 369: 1295-1305
    Search in Google Scholar
  • 4 Goossens S, Ensing S, van der Hoeven M, Roumen F, Nijhuis JG, Mol BW. Comparison of planned caesarean delivery and planned vaginal delivery in women with a twin pregnancy: A nation wide cohort study. Eur J Obstet Gynecol Reprod Biol 2018; 221: 97-104
    CrossrefPubMedSearch in Google Scholar
  • 5 Fox NS, Cohen N, Odom E. et al. Long-term outcomes of twins based on the intended mode of delivery. J Matern Fetal Neonatal Med 2018; 31 (16) 2164-2169
    CrossrefPubMedSearch in Google Scholar
  • 6 Committee on Practice Bulletins—Obstetrics; Society for Maternal–Fetal Medicine. Practice bulletin no. 169: multifetal gestations: twin, triplet, and higher-order multifetal pregnancies. Obstet Gynecol 2016; 128 (04) e131-e146
    CrossrefPubMedSearch in Google Scholar
  • 7 American College of Obstetricians and Gynecologists. ACOG committee opinion no. 560: Medically indicated late-preterm and early-term deliveries. Obstet Gynecol 2013; 121 (04) 908-910
    Search in Google Scholar
  • 8 Taylor M, Rebarber A, Saltzman DH, Klauser CK, Roman AS, Fox NS. Induction of labor in twin compared with singleton pregnancies. Obstet Gynecol 2012; 120 (2, Pt. 1): 297-301
    CrossrefPubMedSearch in Google Scholar
  • 9 Fox NS, Silverstein M, Bender S, Klauser CK, Saltzman DH, Rebarber A. Active second-stage management in twin pregnancies undergoing planned vaginal delivery in a U.S. population. Obstet Gynecol 2010; 115 (2, Pt. 1): 229-233
    Search in Google Scholar
  • 10 Easter SR, Robinson JN, Lieberman E, Carusi D. Association of intended route of delivery and maternal morbidity in twin pregnancy. Obstet Gynecol 2017; 129 (02) 305-310
    CrossrefPubMedSearch in Google Scholar
  • 11 Mei-Dan E, Asztalos EV, Willan AR, Barrett JF. The effect of induction method in twin pregnancies: a secondary analysis for the twin birth study. BMC Pregnancy Childbirth 2017; 17 (01) 9
    CrossrefPubMedSearch in Google Scholar
  • 12 Sheay W, Ananth CV, Kinzler WL. Perinatal mortality in first- and second-born twins in the United States. Obstet Gynecol 2004; 103 (01) 63-70
    CrossrefPubMedSearch in Google Scholar
  • 13 Papiernik E. The rate of preterm twin births (22-27 weeks) as a criterion for measuring the quality of prenatal care. Twin Res 2001; 4 (06) 426-430
    CrossrefPubMedSearch in Google Scholar
  • 14 Roberts CL, Algert CS, Morris JM, Henderson-Smart DJ. Trends in twin births in New South Wales, Australia, 1990-1999. Int J Gynaecol Obstet 2002; 78 (03) 213-219
    CrossrefPubMedSearch in Google Scholar
  • 15 Simões T, Condeço P, Dias E, Ventura P, Matos C, Blickstein I. Induction of labor with oral misoprostol in nulliparous mothers of twins. J Perinat Med 2006; 34 (02) 111-114
    CrossrefPubMedSearch in Google Scholar
  • 16 Tavares MV, Domingues AP, Nunes F, Tavares M, Fonseca E, Moura P. Induction of labour vs. spontaneous vaginal delivery in twin pregnancy after 36 weeks of gestation. J Obstet Gynaecol 2017; 37 (01) 29-32
    CrossrefPubMedSearch in Google Scholar
  • 17 de Castro H, Haas J, Schiff E, Sivan E, Yinon Y, Barzilay E. Trial of labour in twin pregnancies: a retrospective cohort study. BJOG 2016; 123 (06) 940-945
    CrossrefPubMedSearch in Google Scholar
  • 18 Razavi AS, Chasen ST, Chambers F, Kalish RB. Induction of labor in twin gestation: can we predict success?. J Perinat Med 2018; 46 (07) 771-775
    CrossrefPubMedSearch in Google Scholar
  • 19 Kuper SG, Sievert RA, Steele R, Biggio JR, Tita AT, Harper LM. Maternal and Neonatal Outcomes in Indicated Preterm Births Based on the Intended Mode of Delivery. Obstet Gynecol 2017; 130 (05) 1143-1151
    CrossrefPubMedSearch in Google Scholar
  • 20 Malkin JD, Keeler E, Broder MS, Garber S. Postpartum length of stay and newborn health: a cost-effectiveness analysis. Pediatrics 2003; 111 (4, Pt. 1): e316-e322
    CrossrefPubMedSearch in Google Scholar
  • 21 Lee HC, Gould JB, Boscardin WJ, El-Sayed YY, Blumenfeld YJ. Trends in cesarean delivery for twin births in the United States: 1995-2008. Obstet Gynecol 2011; 118 (05) 1095-1101
    CrossrefPubMedSearch in Google Scholar
  • 22 Fox NS, Gupta S, Melka S. et al. Risk factors for cesarean delivery in twin pregnancies attempting vaginal delivery. Am J Obstet Gynecol 2015; 212 (01) 106.e1-106.e5
    CrossrefPubMedSearch in Google Scholar
  • 23 Young BC, Wylie BJ. Effects of twin gestation on maternal morbidity. Semin Perinatol 2012; 36 (03) 162-168
    CrossrefPubMedSearch in Google Scholar
  • 24 Malkin JD, Keeler E, Broder MS, Garber S. Postpartum length of stay and newborn health: a cost-effectiveness analysis. Pediatrics 2003; 111 (4, Pt. 1): e316-e322
    CrossrefPubMedSearch in Google Scholar