Labor In Twin Pregnancies Research Articles

Factors affecting the outcome in multiple gestations

Introduction: Twin births are the commonest form of multiple births. Twins have attracted considerable attention and excited curiosity from early times as a biological variety in the study of the human species. Twin pregnancy is considered as high risk pregnancy. There is poor neonatal outcome in terms of mortality and morbidity. Materials and methods: A retrospective study was conducted from Jan 2015 to Jan 2014 Mac Gann Government General Hospital. During this period there were 2643 deliveries occurred out of which 48 twins and 8 were triplets. Results: In the present study, Incidence of twin pregnancy is 18/1000 live birth. Monozygotic twinning rate is 4.2/1000 live births, while dizygotic twinning rate is 14.2/1000 live births. Perinatal mortality in twins is 177/1000 births as compared to 74.3/1000 births in singleton pregnancy i.e., 2.38 times that of singleton pregnancy. In twin pregnancy Perinatal mortality rate in 1st twin is 62.5/1000 live births while in second twin it is 114.5/1000 births. Frequency of IUGR in twin pregnancy is 85.4%. Risk of preterm labour in twin pregnancy is 64.5%. IUGR babies are more in monochorionic than in dichorionic placenta. Conclusion: Perinatal mortality in twin is higher than in of singleton pregnancy. Risk of single fetal loss (antepartum deaths) in twin pregnancy is higher than risk of both fetal losses. Perinatal mortality rate in 2st twin is double compared to first twin. Perinatal mortality increases as the gestational age decreases. Frequency of IUGR in twin pregnancy is very high and more in monochorionic than in dichorionic placenta.

Trial of labour in twin pregnancies: a retrospective cohort study.

To assess the success rate of vaginal delivery among women with twin pregnancies; the Twin Birth Study has shown that vaginal delivery and caesarean section are equally safe for twin delivery but >40% of the planned vaginal delivery group delivered by caesarean section. A retrospective cohort study. A tertiary medical centre. A total of 2194 women with twin pregnancies not complicated with very low birthweight. Planned mode of delivery was documented in the woman's electronic record upon entering the delivery room. Information regarding maternal age at delivery, parity, gestational age, presentation, previous history of caesarean delivery, birthweight and Apgar score was collected from the obstetric electronic charts. Rate of vaginal twin delivery. Of the 2194 women included, 1311 twin pregnancies had planned caesarean delivery and 883 underwent a trial of labour. Of the 883 women who underwent a trial of labour, the rate of vaginal delivery was 86.9%, whereas the rates of caesarean delivery and combined vaginal-caesarean delivery were 11.1% and 2.0%, respectively. Presentation of second twin, gestational age and maternal age did affect the chances of success. Nulliparity [odds ratio (OR) 2.38, 95% confidence interval (95% CI) 1.4-4.05], Foley induction of labour (OR 2.33, 95% CI 1.38-3.91) and body mass index >30 kg/m(2) (OR 1.76, 95% CI 1.03-3) were independent risk factors for caesarean delivery. The rate of vaginal delivery among women with twin pregnancies who undergo labour can be high, especially in women who laboured spontaneously and have delivered before. The rate of vaginal delivery of twins can be high, especially in women who have delivered before.

Induction of twin pregnancy and the risk of caesarean delivery: a cohort study.

BackgroundComplications are common in twin pregnancies and induction of labour is often indicated. Most methods for induction are used but data on risks related to induction methods are sparse. The aim of this study was to investigate the association between induction of labour and caesarean delivery in twin pregnancies, and to assess the influence of induction method.MethodsCohort study of twin pregnancies ≥ 34 weeks, planned for vaginal delivery, from two University Hospitals in Sweden. Data were collected from medical records during the periods 1994 (Örebro) and 2004 (Uppsala) to 2013. During the study period there were 78,180 live born births and 1,282 were twin births. Women with previous caesarean section were excluded. Induction methods were categorized into amniotomy, oxytocin and cervical ripening (intra cervical Foley catheter or prostaglandin). Adjusted odds ratios (AOR) with 95 % confidence interval (CI) for caesarean section were calculated by logistic regression and were adjusted for parity, maternal age, gestational length, complications to the pregnancy, infant birth weight and year of birth. Spontaneous labour onsets were used as the reference group. The main outcome measure was caesarean section.ResultsIn 462 twin pregnancies, 220 (48 %) had induction of labour and 242 (52 %) a spontaneous labour onset. Amniotomy was performed in 149 (68 %) of these inductions, oxytocin was administered in 11 (5 %) and cervical ripening was used in 60 (27 %). The rate of caesarean sections was 21 % in induced and 12 % in spontaneous labours (p 0.01). The absolute risk of caesarean section following induction was: 15 % with amniotomy; 36 % with oxytocin and 37 % with Foley/prostaglandin. Induction of labour increased the risk of caesarean section by 90 % compared with spontaneous labour onset (AOR 1.9, 95 % CI 1.1-3.5) and, when cervical ripening was used, the risk increased more than two fold (AOR 2.5, 95 % CI 1.2-5.3).ConclusionInduction of labour in twin pregnancies increases the risk of caesarean section compared with spontaneous labour onset, especially if Foley catheter or prostaglandins are required. However, approximately 80 % of induced labours are delivered vaginally.

158: Trial of labor in twin pregnancies: is it justified?

The Twin Birth Study has recently shown that vaginal delivery and cesarean section are equally safe for the delivery of twins. However, more than 40% of the planned vaginal delivery group delivered by cesarean section. Since the chances of success are a crucial part in decision-making regarding mode of delivery, our aim was to determine the rate of vaginal delivery among patients with twin pregnancies, who undergo a trial of labor.

Induction of labor in twin pregnancies with oral misoprostol versus vaginal dinoprostone – is it effective and safe?

Objective: To compare the effectiveness and safety of oral misoprostol versus vaginal dinoprostone for the induction of labor in twin pregnancies.Methods: All twin pregnancies ≥ 34 weeks 0 days that were induced with either misoprostol or dinoprostone in St. Hedwig Hospital between 2002 and 2013 were included in this retrospective study. Length of induction, mode of delivery, maternal and neonatal outcomes were compared between the two groups.Results: After identifying 186 twin mothers matching the inclusion criteria, 154 women were induced with misoprostol (group A) and 32 with dinoprostone (group B). There were no differences in demographic data between the groups. Rates of successful vaginal delivery (53.9% versus 56.3%) and length of induction to delivery (30.2 h versus 26.9 h) were also similar. There were slightly higher rates of postpartum hemorrhage in group B (16.6% versus 10.8%), but without reaching statistical significance. Neonatal outcomes regarding umbilical artery pH <7.20 and one minute Apgar also were without significant differences.Conclusions: Study data indicate that oral misoprostol and vaginal dinoprostone are similarly effective and safe for the induction of labor in twin gestations. Further trials with larger series are needed to confirm these results.

Déclenchement du travail des grossesses gémellaires : comparaison avec les grossesses monofœtales et facteurs associés au risque d’échec

The aim of this study was to evaluate the modalities of induction of labour in twin pregnancies compared with singleton pregnancies and to identify risk factors for failure. A retrospective population-based study was conducted at the Toulouse University Hospital to compare a cohort of diamniotic twin gestations (Twin A in vertex presentation), with induction of labour ≥36 weeks of gestation, between January 2007 and December 2012, to a singleton's cohort that were induced ≥36 weeks of gestation during the 2007 year. One singleton pregnancy was matched for each twin pregnancy with parity and gestational age. One hundred and fifty-six twins pregnancies met the inclusion criteria for an induction of labor and were compared to 156 single pregnancies. The same and standard protocol of induction of labor was used for the two cohorts (intrauterine balloon catheter±dinoprostone/ocytocine). The cesarean section rate for failed labor induction (cesarean in latent phase) was similar in the 2 populations (14.7% for twin vs 13.5% for single; P=0.66). The factors associated to failed induction of labor in the total population were nulliparity (OR=1.49) and Bishop score<6 at the beginning of the induction (OR=2.83). Twin did not appear as risk of failed induction. The protocol for induction of labor in singletons may be safely proposed to twin gestations.

654: Neonatal outcomes of trials of labor in twin pregnancies

654: Neonatal outcomes of trials of labor in twin pregnancies

Is induction of labor risky for twins compare to singleton pregnancies?

Objective: The aim of this study was to investigate whether induction of labor in twin pregnancies is associated with higher rates of maternal complications as compared to singletons.Method: A retrospective population-based study was conducted to compare maternal complications following induction of labor in twin pregnancies and singletons at Soroka University Medical Center, Be'er-Sheva, Israel, between 1988 and 2010. Stratified analysis using a multiple logistic regression model was performed to control for confounders.Results: The study population included 25 913 patients following induction of labor, of these 191 (0.73%) were in twin pregnancies. Induction of labor in twin pregnancies was not associated with adverse maternal outcomes such as cervical tears, third degree perineal tears, uterine rupture, peripartum hysterectomy, post-partum hemorrhage or retained placenta. However, labor induction in twins was significantly associated with cesarean deliveries (31.2% versus 17.1%; p < 0.001).Using a multivariable analysis controlling for confounders, induction at twins was an independent risk factor for cesarean delivery (CD; adjusted OR = 2.2, 95% CI 1.7–2.7, p < 0.001).Conclusion: Induction of labor in twin pregnancies does not increase the risk for maternal complications. However, it is an independent risk factor for CD.

Induction of Labor in Twin Compared With Singleton Pregnancies

To estimate the likelihood of cesarean delivery and length of labor in twin pregnancies undergoing induction of labor as compared with singleton pregnancies. This was a retrospective cohort study of 100 patients with twin pregnancy in one maternal-fetal medicine practice undergoing induction of labor from 2005 to 2012. The control group was 100 randomly selected patients in the same practice with a singleton pregnancy undergoing induction of labor over the same time period. The primary outcome was mode of delivery (vaginal or cesarean). The likelihood of cesarean delivery did not differ between the groups (19% in twins compared with 21% in singletons, P=.724) nor did the time from induction to vaginal delivery (median and interquartile time 9.7 [5.5-12.5] hours in twins compared with 10.4 [6.6, 14.1] hours in singletons, P=.255). Results were not different when we looked at nulliparous patients only or multiparous patients only. On adjusted analysis of risk factors for cesarean delivery in patients undergoing induction, twin pregnancy was not independently associated with cesarean delivery. Patients with twin pregnancies undergoing induction of labor have a similar risk of cesarean delivery and a similar length of labor as patients with singleton pregnancies undergoing induction of labor. II.

24-hour rhythm to the onset of term and preterm labour in twin pregnancies

The objective of this study is to describe the time of onset of contractions in twin pregnancies that result in delivery, so as to investigate whether there is a diurnal influence. A UK maternity department database was used to identify twin deliveries over a 5-year period, and the time of onset of labour was retrieved from these records. Two hundred and eleven women with spontaneous onset of labour in twin pregnancies were studied. A significant diurnal rhythm in the timing of contractions was noted, with 45% of deliveries occurring in labour that commenced between midnight and 08.00 hours. This periodicity is similar for twin pregnancies that end in preterm (24-36 weeks of gestation; χ² = 17.2; P < 0.01) or term deliveries (37-40 weeks of gestation; χ² = 13; P < 0.05). The periodicity of onset of labour in multiple pregnancies demonstrates a similar rhythm to singleton pregnancies, where labour most commonly begins between midnight and 08.00 hours.

The role of phosphorylated insulin-like growth factor binding protein-1 in predicting pre-term labour in twin pregnancies

This was a retrospective study, carried out at Yeovil District Hospital, UK, from January 2006 to December 2008, looking at 40 patients with twin pregnancies. The aim was to evaluate the role of phosphorylated insulin-like growth factor binding protein-1 (IGFBP-1) test in the prediction of pre-term delivery in twin pregnancies. All the patients had a transvaginal ultrasound scan for cervical length at 24 weeks, followed by a high vaginal swab for IGFBP-1 at 26 weeks. A total of 95% of women screened negative for the IGFBP-1 test. None of these women delivered before 30 weeks; 7.50% delivered between 30 and 33+6 weeks; 87.5% delivered after 34 weeks. Two women (5.00%) screened positive for phosphorylated insulin-like growth factor binding protein-1; one had a spontaneous pre-term delivery at 30 weeks, while the other patient delivered at 38 weeks. It was concluded that women with twin pregnancies that have negative phosphorylated insulin-like growth factor binding protein-1 have a low risk of delivery before 34 weeks in the absence of other obstetric complications.

Accouchement par voie basse des grossesses gémellaires sur utérus cicatriciel : peut-on autoriser l’épreuve utérine ?

Objective. – To determine if a trial of labor in twin pregnancy with previous cesarean section is an acceptable alternative to systematic cesarean section. Patients and methods. – Based on a retrospective and comparative study from 1 st January 1996 to 30th June 2003 in Maternité Jeanne-de-Flandre (Lille) and Pavillon Paul-Gellé (Roubaix), 35 trials of labor in twin pregnancies with previous cesarean section have been compared with 35 twin gestations attempting vaginal delivery without a prior cesarean. This comparative study has been led by sorting out the patients according to their gestational age, parity and maternity. Results. – Twenty-seven women (77%) delivered vaginally and eight (23%) by elective caesarean section. Postpartum hemorrhage was more frequent for caesarean section (75%). No scare dehiscence or rupture occurred. There was not any haemostasis hysterectomy or embolisation related to postpartum haemorrhage. Neonatal outcome was similar in both groups. Discussion and conclusion. – Twin trial of labor after a previous cesarean section seems to be a safe alternative to routine repeat cesarean delivery as maternal and fetal morbidity and mortality are safe.

Induction of labor in twin pregnancy after 36 weeks does not increase maternal–fetal morbidity

Objective: To compare maternal and perinatal outcomes in twin pregnancy patients without any fetal or maternal disease, managed by labor induction or expectant management after 36 weeks gestation. Methods: We conducted a case–control study of 81 patients: labor induction ( n=36) vs. expectant management ( n=45). Labor was induced using oxytocin ( n=18), vaginal prostaglandins ( n=6) or intrauterine balloon catheter ( n=12) according to the Bishop score. Maternal and perinatal outcome variables were compared among both groups. Results: The characteristics of the labor induction group and the expectant management group were not statistically different, except for the rate of nulliparae (55.6% vs. 33.3%) and the rate of epidural analgesia (100% vs. 80%). There was no significant difference in labor time (6.5±2.8 h vs. 6.0±3.6 h), cesarean section rate (8.3% vs. 13.3%) or duration of maternal hospitalization (7.3±2.0 days vs. 7.5±2.3 days) in the labor induction group and in the expectant management group, respectively. The birth weight was higher in the labor induction group than in the expectant management group (2639±352 g vs. 2463±298 g, P<0.001). The rate of Apgar score <7 at 5 min was 0% and 3.3%, respectively. Neonatal intensive care unit admission occurred in 30.5% and 26.6% of the groups, respectively. No perinatal death was reported. Conclusion: Induction of labor may be proposed to patients with uneventful twin pregnancy after 36 weeks gestation without increasing maternal–fetal morbidity.

Cesarean delivery of twins and neonatal respiratory disorders

Objective: The objective of this study was to evaluate the risk of neonatal respiratory disorders when cesarean delivery is performed before labor in twin pregnancies. Study Design: We reviewed the charts of all patients with twin pregnancies who underwent cesarean delivery before labor after 36 weeks’ gestation. All cases in which delivery was done for a clear maternal or fetal indication were excluded. Neonatal respiratory disorders included transient tachypnea of the newborn and respiratory distress syndrome. Results: Delivery was performed between 36 weeks’ and 37 weeks 6 days’ gestation in 79 patients (62.7%) and between 38 weeks’ and 40 weeks 2 days’ gestation in 47 patients (37.3%). Respiratory disorders were diagnosed in 15 neonates from 11 pregnancies. Pregnancies in which one or both neonates were diagnosed with respiratory disorders were more likely to have been delivered before 38 weeks’ gestation (90.9% vs 60.0%; P = .04) and were more likely to have been conceived spontaneously (54.5% vs 21.7%; P = .03) than those pregnancies with no affected neonates. Conclusions: Neonatal respiratory disorders are more common in twin pregnancies with cesarean delivery performed before labor before 38 weeks’ gestation. Without a clear indication for delivery, waiting until labor or until after 38 weeks’ gestation should be considered. (Am J Obstet Gynecol 1999;181:1052-6.)

Labour in twin pregnancy. An analysis by parity

SummaryThe purpose of this study was to determine the differences in labour outcome between primigravidae and multigravidae in a twin pregnancy. The course and outcome of labour were analysed by parity in all twin pregnancies delivered in the years 1988/1989. The most dramatic difference was in the incidence of caesarean section, which was 57 per cent (n = 46) in primigravidae compared with 18 per cent (n=123) in multigravidae (P<0005). Of the 15 caesarean deliveries for dystocia, 13 were in primigravidae. Five of the 6 caesarean deliveries for a second twin were in multigravidae. The mean duration of the first stage of labour was 5-5 hours in primigravidae and 2-3 hours in multigravidae (;P< 0-001). The mean duration of the second stage was 25 minutes in primigravidae and 11 minutes in multigravidae (P < 0001). As in singleton pregnancies, the course of labour in twin pregnancies differs between primigravidae and multigravidae.

Failure to prevent preterm labour and delivery in twin pregnancy using prophylactic oral salbutamol

A double blind, controlled study was performed to see whether the use of prophylactic oral salbutamol would reduce the incidence of preterm labour in twin pregnancy. Of the 144 women studied, 74 took salbutamol and 70 placebo. No difference was found in the length of gestation, birthweight or fetal outcome, although fewer babies suffered from respiratory distress syndrome in the salbutamol group. Women did not experience troublesome side-effects from salbutamol.

Tape measurement of symphysis-fundal height in twin pregnancies.

We hypothesized that tape measurement of symphysis-fundal height could be useful in detecting multiple pregnancies, and in such cases in predicting preterm labour and identifying small-for-gestational-age (SGA) fetuses. Although mean fundal height is substantially greater in twin than singleton pregnancies, the value of the technique to detect multiple pregnancies may be limited because combined birth-weight is less and the frequency of SGA fetuses is greater in undiagnosed than in diagnosed twin pregnancies. We found no evidence that the measured fundal height is greater in pregnancies going on to preterm delivery, and we suggest that the commonly accepted theory that the high rate of preterm labour in twin pregnancies results simply from uterine overdistension be reappraised. Nevertheless, fundal height measurement was of value in identifying pregnancies in which both babies were SGA and is therefore recommended as a simple, inexpensive and non-invasive technique.

Epidural analgesia and the length of labour for vaginal twin delivery

SummaryA retrospective study of mothers undergoing labour in twin pregnancy was made comparing epidural analgesia with other analgesia. With epidural analgesia labours were longer and forceps delivery was more likely for both the first and the second twin.

Factors associated with preterm labour and changes in the cervix before labour in twin pregnancy.

A total of 132 twin pregnancies in black African women were studied prospectively after 30 weeks gestation. Delivery occurred before 37 weeks in 32%. There was a trend (0.1 greater than P greater than 0.05) towards a higher preterm delivery rate in nullipara (57%), in women under the age of 20 years (60%) and in those with a height/weight ratio of greater than 2.5 (50%). The cervix was assessed with a score based on the length of the canal minus the dilatation of the internal os. In both term and preterm labour there was a significant relation between a cervical score of 0 or a decrease in cervical score and the onset of labour within the subsequent 14 days (P less than 0.001). By these criteria to predict impending labour, 60% of all labours that ensured within 14 days of the assessment would have been predicted with a 20% false positive rate. When nulliparae were excluded the predictive value of cervical assessment for preterm labour was 80% with a false positive rate of less than 5%. Plasma oestriol levels were significantly higher in the preterm labour group but had no clinical prognostic value.

Ritodrine HCL for the Prevention of Premature Labor in Twin Pregnancies

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