Abstract
BackgroundIn the Twin Birth Study, women at 320/7–386/7 weeks of gestation, in whom the first twin was in cephalic presentation, were randomized to planned vaginal delivery or cesarean section. The study found no significant differences in neonatal or maternal outcomes in the two planned mode of delivery groups. We aimed to compare neonatal and maternal outcomes of twin gestations without spontaneous onset of labor, who underwent induction of labor or pre-labor cesarean section as the intervention of induction may affect outcomes.MethodsIn this secondary analysis of the Twin Birth Study we compared those who had an induction of labor with those who had a pre-labor cesarean section. The primary outcome was a composite of fetal or neonatal death or serious neonatal morbidity. Secondary outcome was a composite of maternal morbidity and mortality. Trial Registration: NCT00187369.ResultsOf the 2804 women included in the Twin Birth Study, a total of 1347 (48%) women required a delivery before a spontaneous onset of labor occurred: 568 (42%) in the planned vaginal delivery arm and 779 (58%) in the planned cesarean arm. Induction of labor was attempted in 409 (30%), and 938 (70%) had a pre-labor cesarean section. The rate of intrapartum cesarean section in the induction of labor group was 41.3%. The rate of the primary outcome was comparable between the pre-labor cesarean section group and induction of labor group (1.65% vs. 1.97%; p = 0.61; OR 0.83; 95% CI 0.43–1.62). The maternal composite outcome was found to be lower with pre-labor cesarean section compared to induction of labor (7.25% vs. 11.25%; p = 0.01; OR 0.61; 95% CI 0.41–0.91).ConclusionIn women with twin gestation between 320/7–386/7 weeks of gestation, induction of labor and pre-labor cesarean section have similar neonatal outcomes. Pre-labor cesarean section is associated with favorable maternal outcomes which differs from the overall Twin Birth Study results. These data may be used to better counsel women with twin gestation who are faced with the decision of interventional delivery.
Highlights
In the Twin Birth Study, women at 320/7–386/7 weeks of gestation, in whom the first twin was in cephalic presentation, were randomized to planned vaginal delivery or cesarean section
A subsequent secondary analysis of women who had a spontaneous onset of labor showed no significant difference in neonatal or maternal outcomes between planned vaginal delivery (VD) and CS11
induction of labor (IOL) or pre-labor CS (PrlCS) were performed for obstetrical or medical indications or electively between 375/7 and 386/7of gestation because evidence suggested that perinatal outcomes would be best during this gestational-age window [10]
Summary
In the Twin Birth Study, women at 320/7–386/7 weeks of gestation, in whom the first twin was in cephalic presentation, were randomized to planned vaginal delivery or cesarean section. We aimed to compare neonatal and maternal outcomes of twin gestations without spontaneous onset of labor, who underwent induction of labor or pre-labor cesarean section as the intervention of induction may affect outcomes. The prevalence of twin gestations is approximately 3% of all pregnancies They carry a higher risk profile compared to singleton gestations [1], some of which may necessitate delivery prior to the spontaneous onset of labor, or pre-scheduled elective cesarean section (CS). As the study compared planned modes of delivery, the population included both those who had a spontaneous onset of labor and those who required intervention to achieve delivery by IOL or pre-labor CS (PrlCS). When facing the need to counsel a patient with twins who requires pre-labor obstetrical intervention, there is still a knowledge gap as to how this intervention, either through IOL or PrlCS, affects neonatal or maternal outcomes
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