Labor In Twin Pregnancies Research Articles

Clinical analysis of 102 cases of labor induction in the third trimester on twin pregnancy

Objective: To investigate the clinical characteristics of induced labor in twin pregnancy and the related factors of induced labor failure. Methods: The clinical data of twin pregnant women who underwent induced labor in Peking University Third Hospital from January 2016 to December 2022 were retrospectively analyzed. According to whether they had labor or not after induction, pregnant women were divided into the success group (pregnant women who had labor after induction, 72 cases) and the failure group (pregnant women who did not have labor after induction, 30 cases). Logistic regression was used to analyze the related factors of induction failure in twin pregnant women. Results: The parity and cervical Bishop score in the failure group were significantly lower than those in the success group, while the proportion of dichorionic diamniotic twins, assisted reproductive technology pregnancy and cervical Bishop score <6, postpartum hospital stay and total hospital stay in the failure group were significantly higher than those in the success group (all P<0.05). The proportion of induced labor by artificial rupture of membranes ± oxytocin intravenous infusion in the success group was 72.2% (52/72), which was significantly higher than that in the failure group (46.7%, 14/30; P=0.030). There were no significant differences between the two groups in the gestational age at delivery, the incidence of severe postpartum hemorrhage and blood transfusion, the amount of postpartum hemorrhage, the neonatal weight of two fetuses, the incidence of neonatal asphyxia, and the proportion of neonates admitted to the neonatal intensive care unit (all P>0.05). There were no severe perineal laceration and hysterectomy in all pregnant women. Multivariate logistic regression analysis showed that primipara (OR=3.064, 95%CI: 1.112-8.443; P=0.030) and cervical Bishop score <6 (OR=5.208, 95%CI: 2.008-13.508; P=0.001) were the independent risk factors for induction failure in twin pregnancy. Conclusions: Elective induction of labor in twin pregnancy is safe and feasible. It is helpful to improve the success rate of induction of labor by strictly grasping the timing and indications of termination of pregnancy, choosing the appropriate method of induction according to the condition of the cervix, and actively promoting cervical ripening.

Induction of labor in twin pregnancy in patients with a previous cesarean delivery

BackgroundTrial of labor after cesarean delivery (TOLAC) in twin gestations has been associated with decreased rates of successful vaginal delivery compared to singleton pregnancies, with mixed results regarding maternal and neonatal morbidity. However, induction of labor (IOL) in this unique population has not yet been fully evaluated.ObjectiveTo assess success rates and maternal and neonatal outcomes in women with a twin gestation and a previous cesarean delivery undergoing IOL.MethodsA retrospective cohort study including women with a twin gestation and one previous cesarean delivery undergoing a trial of labor between the years 2009–2020. Patients requiring IOL were compared to those with a spontaneous onset of labor.ResultsThere were 53 patients who met the inclusion criteria: 31 had a spontaneous onset of labor (58%) and 22 required an IOL. Baseline characteristics were comparable between the groups apart from a history of labor arrest which was more common in the IOL group (40.9% vs. 9.6%, P = 0.006). A successful vaginal delivery occurred in all (100%) women with a spontaneous labor compared to 81% in the IOL group (p = 0.02). Secondary outcomes were comparable. A history of no previous vaginal delivery, maternal obesity, and IOL were associated with TOLAC failure.ConclusionsIOL after cesarean delivery in twin gestation is associated with an increased risk of TOLAC failure compared to spontaneous onset of labor. However, no adverse neonatal or maternal outcomes were found. IOL in this high-risk population is feasible but patients should be counseled about the lower rate of success.

Detection of Twin Pregnancies using Fetal Phonocardiogram.

Fetal phonocardiogram (fPCG), or the electronic recording of fetal heart sounds, is a safe and easily available signal that can be used to monitor fetal wellbeing. In the proposed work an attempt is made to identify twin pregnancies using fPCG data recorded from the fetus with 1/3rd power in octave band filtered output as features to train K-Nearest Neighbor (KNN) and support vector machine (SVM) classifiers. The SVM classifier with the quadratic kernel is able to identify singletons and twins with a positive predictive value of 100% and 79.1% respectively. The KNN classifier with k=10 neighbors is able to identify singletons and twins with a positive predictive value of 100% and 81.8% respectively.Clinical Relevance: Identifying twin pregnancies from singleton is an essential clinical protocol followed during late pregnancy as there may be complications like twin-twin transfusion syndrome, selective fetal growth restriction, and preterm labor in twin pregnancy [1], [2]. Ultrasound imaging is the most commonly used technique for twin pregnancy detection, though it is often not affordable or available in rural or low-income populations. Utilization of fPCG in such circumstances has immense clinical potential.

Neonatal and maternal outcomes with elective cesarean section compared to induction of labor in twin pregnancies: A prospective cohort study

ObjectivesThe aim of this study was to compare neonatal and maternal outcomes in twin pregnancies with elective cesarean section (ECS) and induction of labor (IOL) to better inform women during the counselling process. Materials and methodsWe conducted a cohort study including all twin pregnancies referred to the Department of Obstetrics at Kolding University Hospital, Denmark between January 2007 to April 2019 (n = 819). The primary analysis compared maternal and neonatal outcomes in pregnancies planned for IOL with those planned for ECS after week 34. A secondary analysis compared maternal and neonatal outcomes in pregnancies who underwent IOL followed by successful vaginal delivery with outcomes in those who underwent ECS. ResultsAmong 587 eligible twin pregnancies, the rates of unplanned CS did not differ between those planned for ECS compared to those planned for IOL (38% vs. 33%; p = 0.27). IOL resulted in successful vaginal delivery in 67% (155/231) of those planned for IOL. Maternal outcomes did not differ between women who were planned for, or received, delivery with either IOL or ECS. Regarding neonatal outcomes, significantly more neonates required treatment with C-PAP in ECS group, than in the IOL group, and a higher median number of maturity days among mothers planned for ECS. However, no other significant difference in neonatal outcomes was observed when comparing successful IOL with successful ECS. ConclusionInduction of labor was not associated with worse outcomes compared to elective caesarean section in this large cohort of routinely handled twin pregnancies. In women with twin pregnancies indicated for delivery, who does not go into spontaneous labor, induction of labor is a safe option for both the mothers and their neonates.

Effectiveness of dinoprostone gel, misoprostol vaginal insert and dinoprostone vaginal insert for induction of labour in twin pregnancies

ObjectivesTo compare the effectiveness and safety of Dinoprostone Gel (DG), Misoprostol Vaginal Insert (MVI) and Dinoprostone Vaginal Insert (DVI) for induction of labour (IOL) in twin pregnancies. Study DesignRetrospective cohort study of twin pregnancies > 34 + 0 weeks gestation that underwent induction of labour (IOL) with DG, MVI or DVI between December 2016 and November 2019 in a Tertiary NHS hospital, North West England, UK. Delivery characteristics, maternal complications and neonatal outcomes were compared between the three groups. ResultsA total of 87 twin pregnancies were included for analysis. 27 women received DG, 34 received MVI and 26 DVI. The MVI cohort had a higher proportion of nulliparous women (55.9%) compared to the DG and DVI cohorts, 29.6% and 38.5% respectively. No other differences amongst demographic characteristics were considered clinically significant.DG demonstrated a significantly quicker time to delivery (minutes) compared to DVI (1021 ± 556 versus 1649 ± 852; P = 0.0026). Significantly fewer women required terbutaline for hyperstimulation/tachysystole in the DG group compared to MVI (0% vs 32%; RR 0.05; 95% CI 0.003–0.88). Both DG and MVI groups required significantly less oxytocin following artificial rupture of membranes compared to DVI (33% vs 65%; RR 0.51; 95% CI 0.28–0.93) and (29% vs 65%; RR 0.45; 95% CI 0.25–0.81). There were no significant differences in mode of delivery, maternal complications and neonatal outcomes. ConclusionOur data suggests that for women with a twin pregnancy considering a planned labour that induction with DG, MVI and DVI appear to be equally safe and effective IOL methods. These results should be interpreted with caution due to the study being underpowered to detect significant adverse outcomes. In order to determine the optimal method of IOL in twins, direct randomised comparison is needed.

Comparison of international guidelines on the management of twin pregnancy

ObjectivesTo review current international clinical guidelines on the antenatal and intrapartum management of twin pregnancies, examining areas of consensus and conflict. MethodsWe conducted a database search using Medline, Pubmed, Scopus, Academic Search Complete, CINAHL and ERCI Guidelines website. Guidelines were screened for eligibility using our inclusion and exclusion criteria. Those deemed eligible were quality assessed using the AGREE II tool and relevant data was extracted. ResultsWe identified 21 relevant guidelines from 16 countries including two international society guidelines. There was consensus in determination of chorionicity and amnionicity within the first trimester, fetal anomaly scan between 18 and 22 weeks and the recommended screening for twin-to-twin transfusion syndrome (TTTS).For those that provided intrapartum guidance, there was agreement in recommending caesarean section to deliver monochorionic monoamniotic (MCMA) twins, epidural anaesthesia for intrapartum analgesia and the use of cardiotocography (CTG) for intrapartum fetal monitoring.The main areas of conflict included cervical length screening, frequency of ultrasound surveillance, timing of delivery of dichorionic twin pregnancies and circumstances for recommending vaginal delivery. There was a lack of advice on intrapartum management. ConclusionsThis review has highlighted the need for unified international guidance on the management of twin pregnancy. Comparisons of current guidance demonstrates a lack of confidence in the management of labour in twin pregnancies. Further evidence on intrapartum care of twin pregnancies is needed to inform practice guidelines and improve both short and long term maternal and fetal outcomes.

Does Progesterone Prevent Preterm Labor in Complicated Monochorionic Twin Pregnancies after Radiofrequency Ablation of One Fetus?

Background: Twin pregnancies have a higher risk of preterm labor than singletons. Otherwise, progesterone using to reduce the risk of preterm labor in twin pregnancies remains controversial. Therefore, this study evaluated the effect of intramuscular progesterone to prevent preterm labor in complicated monochorionic diamniotic twin pregnancies after Radiofrequency Ablation (RFA) of one fetus.&#x0D; Methods: Pregnant women with monochorionic diamniotic twin pregnancies of 16 to 26 weeks of gestational age in an academic center were randomly assigned to receive intramuscular 17-hydroxy progesterone caproate weekly until 36 weeks of gestational age after RFA of one fetus and a control group who did not receive intervention after RFA. Demographic and obstetrical characteristics, as well as maternal, fetal and neonatal outcomes were compared between groups.&#x0D; Results: In total, 79 participants were recruited in the study. The mean±SD of gestational age at delivery in case and control groups were 34.6±3.8 and 34.6±5.1 with no significant difference (p=0.967). Neonatal outcomes including birth weight (p=0.870), intensive care unit admission (p=0.415), premature preterm rupture of membrane (p=0.115) and pregnancy outcome (live birth, fetal demise or neonatal death) (p=0.524) were not different either. Indeed, gestational age at delivery was inversely related to cervical length at the time of procedure and maternal body mass index, but these differences were not statistically significant. Also, there was no significant difference in terms of gestational diabetes, which was a worrying complication of 17-hydroxy progesterone caproate.&#x0D; Conclusion: Although 17-hydroxy progesterone caproate seems to be safe with no apparent maternal and neonatal side effects, it does not prolong pregnancy after RFA. Further studies with longer follow up and larger sample size are suggested.

Evaluation of the predictive role of anterior uterocervical angle in preterm labor in twin gestation through meta-analysis: anterior uterocervical angle and preterm labor in twin gestation

Multiple gestations are high-risk pregnancies with increased obstetric and perinatal risks. Preterm labor occurs in about half of twin pregnancies. Thus, prediction of the time of delivery and prevention of premature birth are very important in multiple gestations. Anterior uterocervical angle is a successful tool that has been used in the prediction of preterm labor in recent years. However there is only limited data about this issue for twin pregnancies in the literature. Here, we aimed to demonstrate the relationship between uterocervical angle and preterm labor in twin pregnancies more clearly and reliably with this meta-analysis. In this context, “twin gestation, uterocervical angle, cervical angle, angle, cervix, cervical, preterm and preterm labor” keywords were used and PubMed, Medline, ClinicalKey, Scopus, Science Direct, Web of Science, and Google Scholar database were searched between 1 January 2010 and 27 December 2020. Finally, a total of three studies were included in the analysis. Here, we found that uterocervical angle was associated with a higher risk of preterm delivery in the overall effect.

Induction of labor in twin pregnancies – A retrospective cohort study

ObjectiveTo investigate outcomes in spontaneous and induced twin deliveries. Secondary aims were to study impact of delivery interval and breech presentation of the first twin. MethodsThis retrospective cohort study comprised 354 twin deliveries at a tertiary Norwegian hospital. Spontaneous labor onset and induction of labor were compared in women with planned vaginal delivery and gestational age ≥ 34 weeks. The main outcome was intrapartum cesarean section. Secondary outcomes were umbilical arterial pH and five-minute Apgar scores. ResultsAmong the induced labors, 63/229 (27.5%) women underwent intrapartum cesarean section, compared to 45/125 (36%) in spontaneous labors (P = 0.10). Odds ratio for intrapartum cesarean section in induced labors was 0.65 (95% CI 0.40–1.04) after adjusting for maternal age and parity.Median umbilical arterial pH was significantly lower in the second twins in both spontaneous and induced labors, 7.28 (6.94–7.43) vs. 7.32 (7.16–7.42), and 7.27 (6.90–7.48) vs. 7.29 (7.08–7.45), respectively. pH < 7.00 rarely occurred. Second twins born after a delivery interval > 30 min had a significantly higher frequency of pH < 7.10 than those with a shorter interval, P < 0.01. No significant difference was found in frequency of pH < 7.10 between breech-presenting and cephalic-presenting first twins (P = 0.65). One unexpected intrapartum fetal death occurred after labor induction. ConclusionOur results support spontaneous onset and induction of labor as safe. Intrapartum cesarean section rates did not differ significantly between spontaneous and induced labors. Delivery interval > 30 min was associated with a lower pH in the second twin.

A randomized controlled trial of two-doses of vaginal progesterone 400 vs. 200mg for prevention of preterm labor in twin gestations.

To compare between the effectiveness and safety of two different daily doses of vaginal progesterone (400 vs. 200mg) in the prevention of preterm labor in twin pregnancy. This is a prospective single-blinded randomized controlled trial conducted on 100 primi-gravida who had twin pregnancy and attended the antenatal clinic of a University hospital. They were equally and randomly allocated into two arms each containing 50 patients. Arm 1 received 400mg and arm 2 received 200mg vaginal progesterone daily at bed time starting from 14weeks of pregnancy to 36weeks. Transvaginal ultrasound was performed for assessment of the length of cervix at 14 and 22weeks. Both arms of the current study were comparable regarding the cervical length at 14 and 22weeks, mean gestational age at delivery, incidence of pre-term delivery, birth weight of the first twin. Second twin in addition to the average weight of both twins. No statistical significance differences between two arms regarding incidence of early neonatal death. NICU, mechanical ventilation, length of admission in NICU for the first twin. Second twin as well as both twins. Vaginal progesterone treatment with different doses was tolerable, but wasn't effective in the prevention of preterm labor in twin pregnancy.

The impact of prolonged second stage in twins on perinatal outcomes.

To assess the duration of the second stage of labor in twin pregnancies in relation to maternal and neonatal outcomes. A retrospective study between 2014 and 2020. Eligible cases were twin pregnancies that reached the second stage. The pre-defined groups were based on the total time spent in the second stage of labor; Group 1 (<1h), group 2 (1-2h), and group 3 (>2h), which was considered the prolonged second stage group. Among the 439 planned vaginal births, successful vaginal delivery of both twins was achieved in 63.8%. Prolonged second stage was observed in 25.8% (89/345). Nulliparity (odds ratio [OR] 7.72, 95% confidence interval [CI] 4.5-13.4) and use of epidural analgesia (OR 5.45, 95% CI 1.2-24.7), were the only independent variables significantly associated with prolonged second stage. Prolonged second stage was associated with a greater risk of intrapartum cesarean delivery (32.6%, P<0.001), combined delivery (10.1%, P<0.001), chorioamnionitis (8.3%, P=0.006) and a admission to neonatal intensive care unit of at least one of the twins (30.3%, P=0.02). Prolonged second stage of labor affects maternal and fetal outcome in twin pregnancies.

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

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)

Cervical Length as a Predictor of Latency to Labour in Twin Pregnancies Complicated by Preterm Pre-Labour Rupture of Membranes: A Retrospective Study.

Preterm pre-labour rupture of membranes (PPROM), one of the leading causes of preterm delivery, represents a serious economic and psychosocial health care burden. The unpredictability of the interval between PPROM and labour, also known as the latency period, can be unsettling for patients and clinicians alike. In singleton pregnancies, the literature supports the use of ultrasound-determined cervical length to estimate the latency period. With this retrospective cohort study, we sought to determine whether a shorter cervical length (≤25 vs. >25 mm) is associated with a shorter latency period in twin pregnancies complicated by PPROM. At McMaster University Medical Centre, a tertiary care centre, we used the Better Outcomes Registry Network (BoRN) database to identify patient records that met our criteria for inclusion over a 5-year period. Forty-three records were included in our analysis. On average, shorter cervical length was statistically significantly associated with a 6-day shorter latency period (P = 0.035). Confounders were controlled for using ANCOVA statistical analysis. A moderate, positive correlation between cervical length and latency period was also identified (r = 0.4). Understanding that a shorter cervical length is associated with a shorter latency period can assist clinicians in optimizing maternal counselling and patient care, including triaging transfers to tertiary care centres.

881: The optimal timing of induction of labor in uncomplicated twin pregnancy

Recent guidelines recommend the planned delivery in twin pregnancy as 38 weeks for uncomplicated dichorionic twin pregnancies and as 34-37+6 weeks for uncomplicated monochorionic diamniotic twin pregnancies. However, the optimal timing of induction of labor in twin pregnancies has not been well studied. In the current study, we compared the pregnancy and neonatal outcomes between women with induction at 37 weeks and those who were nonintervention at 37 weeks and allowed the pregnancy to progress after the time. The study population consisted of 1228 term twin pregnant women who were candidates for trial of labor. They were divided into 2 groups: group 1, women who were planned as induction of labor at 37-37+6 weeks (induction group, n=488 in dichorionic twin, 143 in monochorionic twin); group 2, women who were nonintervention at 37 weeks and allowed the pregnancy to progress after the time. (expectant management group, n=384 in dichorionic twin, 92 in monochorionic twin). The timing of induction after 38 weeks in group 2 was at the discretion of the attending physician. Women who delivered due to obstetric indication (ex. preeclampsia, oligohydramnios, fetal growth restriction) and cases with fetal death in utero or fetal anomaly were excluded. The primary outcome was cesarean section rate and perinatal outcomes (Apgar scores, neonatal intensive care unit (NICU) admission, umbilical cord blood gases, neonatal morbidity). No significant differences were observed in cesarean delivery rate between two groups regardless of chorionicity. In monochorionic twin pregnancies, neonates born to women in group 2 (expectant management group) had higher risk for admission to NICU and lower pH in cord blood than neonates in group 1. In dichorionic twin pregnancies, the perinatal outcomes were not different between the two groups. Induction of labor at 37 weeks resulted in reduced adverse perinatal outcomes compared to expectant management in monochorionic twin pregnancies. The optimal timing of induction of labor in dichorionic pregnancies beyond 38 weeks needs further studies.

Induction of labor in twin gestation: can we predict success?

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) &gt;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 &lt;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 &gt;1500 ml, uterine atony and the use of ≥1 uterotonic agent were more frequent in the CD group. Conclusions: Multiparous women and those &lt;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.

Association between total dose of ritodrine hydrochloride and pulmonary oedema in twin pregnancy: a retrospective cohort study in Japan

ObjectivePulmonary oedema is recognised as a severe side effect of ritodrine hydrochloride. Recently, the number of twin pregnancies has been increasing. Few studies have reported the association between total dose...

Effect of vaginal progesterone in tocolytic therapy during preterm labor in twin pregnancies: Secondary analysis of a placebo-controlled randomized trial.

Our aim was to investigate the effect of the prophylactic use of vaginal progesterone on the latency period from the initiation of tocolytic therapy to delivery in twin pregnancies with preterm labor. This study was a secondary analysis of a randomized, double-blind, placebo-controlled trial of twin pregnancies in mothers who were exposed to a 200mg vaginal progesterone ovule or a placebo ovule daily from 18 to 34weeks gestation. Patients who were administered tocolysis with Atosiban because of preterm labor were included. The latency from tocolysis to delivery, mean gestational age at delivery and the rates of delivery within 48h and within seven days were compared between progesterone and placebo groups. The analysis included 27 women in the progesterone group and 30 in the placebo group. The baseline characteristics were similar between the groups. Overall, there were no differences in the latency period to delivery (17.54±13.54days and 21.58±13.52days; P=0.289), rates of delivery within 48h (14.8% and 6.7%; P=0.40) or within seven days (29.64% and 23.3%; P=0.76) or mean gestational age at delivery (32.53±3.33 and 34.13±2.87; P=0.08) between the progesterone and placebo groups, respectively. Prophylactic use of 200mg of vaginal progesterone does not influence the latency to delivery in women with twin pregnancies treated with tocolysis because of preterm labor.

Long-term outcomes of twins based on the intended mode of delivery

Objective: Recent studies have shown that for twin pregnancies with a cephalic presenting first twin, planned vaginal delivery is not associated with adverse short-term neonatal outcomes, as compared to planned cesarean delivery. Our objective was to compare long-term outcomes in twins, based on planned mode of delivery.Study design: This was a prospective, observational cohort of twin pregnancies delivered by a single MFM practice. All the patients with a twin pregnancy >34 weeks delivered from 2005–2014 were surveyed regarding pediatric outcomes at or after 2 years of life. The survey was mail-based, with phone follow-up for nonresponses or for clarification of answers. Using chi-square, Student’s t-tests, and regression analysis we compared outcomes between women who planned a vaginal (with active management of the second stage) versus cesarean delivery. The main outcome measures were: (1) a composite of major adverse outcomes (death, cerebral palsy, necrotizing enterocolitis, chronic renal, heart, or lung disease); (2) a composite of minor adverse outcomes (learning disability, speech therapy, occupational therapy, physical therapy).Results: Five hundred and thirty-two women met inclusion criteria and 354 (66.5%) responded. 178 (50.3%) women planned to have a cesarean delivery (100% of whom had a cesarean delivery) and 176 (49.7%) women planned to have a vaginal delivery (83% of whom had a vaginal delivery). The average age of the children at the time of the survey was 5.9 years. There were no differences in any pediatric outcomes between the two groups. After controlling for maternal age, IVF, obesity, and preeclampsia, the planned mode of delivery was not associated with a composite of major adverse outcomes (aOR 0.673, 95% CI 0.228, 1.985), nor a composite of minor adverse outcomes (aOR 0.767, 95% CI 0.496, 1.188).Conclusions: Planned vaginal delivery with active management of the second stage of labor in twin pregnancies >34 weeks is not associated with adverse childhood outcomes.

Trial of Labor in Twin Pregnancies: A Retrospective Cohort Study

(BJOG. 2016;123:940–945) Retrospective studies on vaginal deliveries for twin pregnancies have reported greater fetal risk, primarily for the second twin, than cesarean deliveries. The Twin Birth Study was a recent prospective, randomized study that assigned women to planned vaginal or cesarean delivery. It assessed the success rate and safety of vaginal delivery compared with cesarean delivery among a total of 2804 twin pregnancies. This study found that both delivery modes were equally safe; however, 43.8% of women in the planned vaginal delivery group ultimately delivered by cesarean section. The current investigators analyzed the success rate of trial of labor for twin pregnancies at their tertiary care medical center in Israel.

Differing In Vitro Potencies of Tocolytics and Progesterone in Myometrium From Singleton and Twin Pregnancies.

We compared the relaxant effect of 2 known tocolytics; indomethacin and atosiban and progesterone, on pregnant human myometrial spontaneous and oxytocin-induced contractions from singleton and twin pregnancies. All agents exerted a concentration-dependent relaxant effect on myometrial contractions. There was no significant difference in the concentration-response curves between singletons and twins for progesterone or indomethacin on spontaneous contractions or atosiban on oxytocin-induced contraction. Under oxytocin however, the concentration-response curves for indomethacin and progesterone were significantly shifted to the right for both amplitude of contraction (P < .01) and activity integral (P < .01). When compared to singleton myometrium however, the concentration-response curves were significantly shifted to the right in the twin myometrium group (P < .05 progesterone and P < .001 indomethacin). We conclude that a greater concentration of progesterone and indomethacin is required to inhibit oxytocin-induced myometrial contractions in twins compared to singletons in vitro. The differences noted in the tissue pharmacologies may have implications for the successful prevention or inhibition of preterm labor in twin pregnancy.