Comparison of induced versus spontaneous labor in twins

Abstract

Objective: To compare intrapartum outcomes of women with twin gestations undergoing an induction of labor versus spontaneous labor. Study design: This retrospective investigation included women with twin gestations undergoing a trial of labor between January 1995 and June 200. Only diamniotic twins with twin A presenting as a vertex at 24–40 weeks of gestation and women with an unscarred uterus were included. Statistical analysis was done using McNemar’s test, paired t test, and Wilcoxon signed rank test for paired samples. Results: A total of 121 patients underwent a trial of labor that was either induced (n = 40) or spontaneous (n = 81). No differences between groups were observed for maternal age, race, parity, and gestational age. Labor that was spontaneous eventually required augmentation in all cases. Labor that was induced, rather than spontaneous with augmentation, required a higher maximum dose (17.3 versus 7.3 mU/min , P <0.01) and a longer duration (688 versus 239 minutes, P <0.01) of oxytocin. Interruption of oxytocin infusion was uncommon when labor was either induced or later augmented (15% versus 13%). A greater need for cesarean delivery of twin A was found in the induced labor group (30.0% versus 9.8%, P <0.05). Conclusion: Labor in twin gestations that was induced, rather than spontaneous, required more time and was associated with a higher cesarean delivery rate.