Induction of labor in twin gestation: can we predict success?
-
Armin S. Razavi
,
Stephen T. Chasen
Abstract
Objective:
To identify factors associated with a successful induction of labor in twin pregnancies and associated maternal morbidity.
Study design:
This was a retrospective review of twin pregnancies ≥24 weeks’ gestation undergoing labor induction from 2011 to 2016. The primary outcome was a successful induction of labor. The secondary outcome was a composite of maternal morbidity, including ≥1 of the following: estimated blood loss (EBL) >1500 ml, blood transfusion, hysterectomy, intensive care unit (ICU) admission or maternal death.
Results:
Of 104 twin pregnancies undergoing labor induction, 64 (61.5%) had a vaginal delivery of both twins. Multiparity [odds ratio (OR) 12.3, 95% confidence interval (CI) 3.9–38.8, P≤0.005] and maternal age <35 years (OR 2.33, 95% CI 1.1–5.2, P=0.038) were independently associated with vaginal delivery. The overall rate of composite maternal morbidity was 7.7%. Cesarean delivery (CD) was associated with an increased rate of composite maternal morbidity compared to the successful induction group (17.5% vs. 1.6%, P≤0.005). An EBL >1500 ml, uterine atony and the use of ≥1 uterotonic agent were more frequent in the CD group.
Conclusions:
Multiparous women and those <35 years of age were more likely to have a vaginal delivery. Maternal morbidity is increased in women who required a CD after labor induction compared to those who achieved a vaginal delivery.
Acknowledgments
There is no source of financial support for the research.
Author’s statement
Conflict of interest: Authors state no conflict of interest.
Material and methods: Informed consent: Informed consent has been obtained from all individuals included in this study.
Ethical approval: The research related to human subject use has complied with all the relevant national regulations, and institutional policies, and is in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional review board or equivalent committee.
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Article note:
Presented at the Society for Maternal Fetal Medicine’s 37th Annual Pregnancy Meeting January 23–27th, 2017, Las Vegas, NV, Abstract #452 and #733.
©2018 Walter de Gruyter GmbH, Berlin/Boston
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Articles in the same Issue
- Frontmatter
- Editorial
- Antenatal and prepregnancy care – prevention of perinatal morbidity and mortality
- Review article
- Fetal interventional procedures and surgeries: a practical approach
- Opinion paper
- Inverted pyramid of prenatal care – is it enough? Should it be – extended inverted pyramid of prenatal care?
- Research articles
- Expectant management in di-chorionic pregnancies complicated by discordant anomalous twin
- Pregnancy outcomes among patients with recurrent pregnancy loss and uterine anatomic abnormalities
- Early postnatal echocardiographic assessment of pulmonary blood flow in newborns with congenital diaphragmatic hernia
- Sonographic prediction of small and large for gestational age in breech-presenting fetuses
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- Can early ultrasonography explain the lower miscarriage rates in twin as compared to singleton pregnancies following assisted reproduction?
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- Commentary
- Professionally responsible management of gynecologic cancer in pregnancy when clinical resources are unavoidably limited
- Letters to the Editor
- Erroneous conclusion due to mis-calculation of data: reply to Rai SE, Sidhu AK, Krishnan RJ. Transfusion-associated necrotizing enterocolitis re-evaluated: a systematic review and meta-analysis. J Perinat Med 2017
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