Clinical factors associated with failed trials of labor in late preterm and term twin pregnancies

Ko, Hyunjung; Jun, Jong Kwan

doi:10.1515/jpm-2013-0256

Cited by 3 publications

(9 citation statements)

References 29 publications

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“…After multivariate analysis, independent risk factors of CS were nulliparity and non‐cephalic presentation of the second twin. Of these, nulliparity showed the strongest relation to unsuccessful vaginal twin delivery, as has previously been reported 17‐22 …”

Section: Discussionsupporting

confidence: 71%

“…Further, we had the data about the fetal presentations at the time of admittance and were able to compare them with presentations at delivery, which is not often reported in retrospective studies. 14,[17][18][19]21 The fetal presentations remained relatively stable throughout the delivery, especially with the C/C group. The TOL rate was high in twin pregnancies of ≥35 +0 weeks of gestation, and the majority of those who attempted VD achieved it.…”

Section: Discussionmentioning

confidence: 88%

“…Other studies have also searched for risk factors of failed TOL among twin pregnancies, but in those studies the TOL rate was much lower, ranging between 43.1% and 50.5%. 17,19,20,22 The retrospective design is the main limitation of this study, but in our opinion it would be unethical to expose patients to CS without a medical cause. In addition, some study groups may be underpowered when it comes to revealing small differences in some rare outcomes.…”

Section: Discussionmentioning

confidence: 96%

“…Further, with cephalic‐presenting twin pairs, TOL was planned for 89.3% and VD was successful in 82.8% of these cases. Other studies have also searched for risk factors of failed TOL among twin pregnancies, but in those studies the TOL rate was much lower, ranging between 43.1% and 50.5% 17,19,20,22 …”

Section: Discussionmentioning

confidence: 99%

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Risk factors of unsuccessful vaginal twin delivery

Ylilehto

Palomäki

Huhtala

et al. 2020

Acta Obstet Gynecol Scand

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Introduction: Twin trial of labor presents a challenge to obstetricians, as it is associated with a greater number of adverse birth outcomes compared with singleton deliveries. The risk of poor outcome has shown to be highest with unsuccessful vaginal twin delivery. The purpose of this study was to identify the clinical risk factors associated with intrapartum cesarean section in late preterm and term twin births. Material and methods: All live diamniotic twin deliveries of at least 35 +0 weeks of gestation with planned vaginal delivery were included in this retrospective singlecenter cohort study. Maternal and newborn characteristics were compared between a vaginal delivery group and an intrapartum cesarean section group. Logistic regression analysis was carried out to determine independent risk factors of intrapartum cesarean section. Further, maternal and neonatal outcomes were compared between groups of vaginal delivery and cesarean section for both twins and also between groups of vaginal delivery and cesarean section for the second twin only (combined delivery). The impact of presentation of the second twin on the mode of twin delivery and on neonatal outcome was also examined. Results: Among 821 twin pregnancies, 581 mothers (70.8%) attempted trial of labor and were eligible for the study. With a cephalic-presenting first twin, the trial of labor rate was 89.3% and vaginal delivery was successful in 82.8%. Nulliparity (odds ratio [OR] 3.2, 95% confidence interval [CI] 2.0-5.1) and non-cephalic presentation of the second twin (OR 3.0, 95% CI 1.9-4.8) were found to be independent risk factors of cesarean section. However, 76.1% of mothers with non-cephalic second twins achieved vaginal delivery and perinatal outcomes were comparable with cases of cephalic-presenting second twins. When comparing delivery modes, maternal outcomes were more favorable with vaginal delivery, whereas combined delivery increased the second twin's risk of adverse neonatal outcome. Conclusions: This study, with high rates of trial of labor and successful vaginal twin delivery, found nulliparity and non-cephalic presentation of the second twin to be risk factors of intrapartum cesarean section in twin pregnancies.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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Risk factors of unsuccessful vaginal twin delivery

Ylilehto

Palomäki

Huhtala

et al. 2020

Acta Obstet Gynecol Scand

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“…Weight difference is related to worst neonatal outcomes, regardless the delivery mode [31], and also to unsuccessful attempt of labor [32]. Furthermore, a weight difference above 40%…”

Section: Fetal Weight Estimation In Twin Pregnanciesmentioning

confidence: 99%

Time and Mode of Delivery in Twin Pregnancies

Santana¹,

Corrêa²,

Bottura³

et al. 2019

Multiple Pregnancy - New Challenges

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There are many suitable recommendations for twin gestation term in the literature. In many protocols, resolution is recommended for dichorionic pregnancies around 38 weeks, at 36 weeks for monochorionic (devoid of complications) and at 32-34 weeks in cases of single amniotic chamber. The main risk associated with vaginal delivery is connected to the possibility of anoxia of the second twin. However, a cesarean delivery performed by non-cephalic presentation of the second twin is associated with increased maternal morbidity without improved neonatal outcome. The most important factors in the decision of the delivery mode include the presentation of the fetus, gestational age, and weight or the weight difference between the fetuses.

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