457 The effect of second-stage duration in twins on maternal and neonatal outcomes

Abstract

In singleton pregnancies we allow an extended time in the second stage of labor for nulliparous and multiparous women before diagnosing second-stage arrest. The optimal duration of second stage of labor in twin pregnancies has not been defined. We assessed the duration of the second stage of labor in twin pregnancies in relation to maternal and neonatal outcomes. A retrospective study between January 2014 and January 2019. Eligible cases were twin pregnancies beyond 34 weeks’ gestation who reached the second stage of labor with the leading twin in a vertex presentation. We excluded women with previous cesarean deliveries and major fetal anomaly to one of the twins. Second stage of labor was defined from complete cervical dilation to delivery of the second twin. The pre-defined groups were based on the total time spent in the second stage of labor; group 1 (up to 2 hour), group 2 (> 2 hours). The primary outcome of the study was the rate of cesarean delivery. Of the women attempted vaginal delivery (374/777, 48.1%), 294 (78.6%) reached the second stage. Demographic characteristics are presented in Table 1. Women in group 2 were more likely to be nulliparous, used epidural analgesia and younger than group 1. The longer the duration of the second stage of labor, the greater the risk of intrapartum cesarean delivery (2% in group 1 versus 32% in group 2, odds ratio 5.7 [3.3-9.8]) (Table 2). Similarly, we have noticed a significant higher rate of umbilical artery cord pH ≤ 7.0 and admission to neonatal intensive care unit of at least one of the twins in group 2 of extended second stage. No difference was noted in the incidence of the other secondary outcomes. Extended second stage of labor in twins beyond 2 hours is associated with increased incidence of intrapartum cesarean delivery, low umbilical artery cord pH ≤ 7.0 and admission to neonatal intensive care unit. In order to optimize perinatal outcomes in twin pregnancies, more studies are needed to exam the optimal duration of second stage in twin pregnancies.View Large Image Figure ViewerDownload Hi-res image Download (PPT)