Term twin birth – impact of mode of delivery on outcome

Ylilehto, Elina; Palomäki, Outi; Huhtala, Heini; Uotila, Jukka

doi:10.1111/aogs.13122

Cited by 34 publications

(30 citation statements)

References 31 publications

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“…Our nding of fewer maternal adverse outcomes with CS is in contrast to studies performed by Drassinower et al 18 and Ylilehto et al 19 . Drassinower's study of 1009 twin pregnancies found no signi cant difference in maternal hemorrhage or need for blood transfusion between cases of trial of labor or CS 18 .…”

Section: Discussioncontrasting

confidence: 98%

Cesarean delivery or induction of labor in pre-labor twin gestations: A secondary analysis of the Twin Birth Study

Dougan

Gotha

Melamed

et al. 2020

Preprint

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Background: 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. 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.Methods: In 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: NCT00187369Results: Of the 2,804 women included in the Twin Birth Study, a total of 1,347 (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). Conclusion:In 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.

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Section: Discussioncontrasting

confidence: 98%

Cesarean delivery or induction of labor in pre-labor twin gestations: A secondary analysis of the Twin Birth Study

Dougan

Gotha

Melamed

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Our data showed that CS was significantly associated with postpartum haemorrhage. There were studies supporting our finding that mothers in the CS group were significantly more likely to have hemorrhage and surgical complications 23,29 , whereas other studies showed that mothers were more likely to suffer from haemorrhage with VD 30 . There were also studies with neutral findings showing no significant differences in postpartum haemorrhage rates between CS and VD 31,32 .…”

Section: Maternal Outcomes and Mode Of Deliverysupporting

confidence: 79%

Trends in Caesarean section rates for twin pregnancies: a 20-year cohort study

Wong

Kong

2019

Hong Kong Journal of Gynaecology, Obstetrics and Midwifery

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Objective: To evaluate trends in Caesarean section (CS) rates for twin pregnancies over 20 years in a regional obstetric unit in Hong Kong. Methods: Data on twin deliveries between 1998 and 2017 at United Christian Hospital were collected. CS rates were calculated for each calendar year, and data were stratified into four 5-year intervals to determine trends. Twins delivered vaginally or by CS were compared in terms of maternal epidemiological risk factors, pregnancy characteristics, and pregnancy outcome. A logistic regression model was used to determine significant risk factors associated with CS. Results: From 1998 to 2017, 1083 (1.24%) of 87 480 deliveries were twin deliveries. The total CS rate for twins progressively increased from 58.9% in 1998-2002 to 84.1% in 2013-2017, particularly the CS rate for cephalic + cephalic twins from 41.7% in 1998-2002 to 74.7% in 2013-2017. The CS rate for non-cephalic first twin was close to 100% for all intervals. Logistic regression analysis showed that CS was positively associated with noncephalic presentation of the first twin (odds ratio [OR]=13.1), previous CS (OR=4.19), and advanced maternal age (OR=1.7) and negatively associated with preterm delivery (OR=0.34), multiparity (OR=0.29), and induction of labour (OR=0.086). For perinatal outcome, CS was significantly associated with higher mean birthweight, lower incidence of adverse perinatal or neonatal outcome but higher risks of postpartum haemorrhage. Conclusion: A progressive increase in CS rates for twins was observed over the past 20 years, particularly among cephalic-presenting twins, despite the lack of clear evidence on the preferred mode of delivery for such twin pregnancies.

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“…However, a recent study found no effect of chorionicity and twin-to-twin DTI on the short-term outcome of second twin after 36 weeks of gestation (Hjortø et al 2014). But there is a risk for substantial bias, as a higher incidence of complications during pregnancy are probably to be found in MC twins and the problematic ones are possibly selected for caesarean section (Ylilehto et al 2017). A higher prevalence of preterm delivery, severe birthweight discordance (>20%), twin-to-twin transfusion syndrome and stillbirths has been found in MC twins (Hoffman et al 2012).…”

Section: Introductionmentioning

confidence: 99%

Short-term outcome of the second twin during vaginal delivery is dependent on delivery time interval but not chorionicity

Axelsdóttir

Ajne

2018

Journal of Obstetrics and Gynaecology

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The decrease in pH in monochorionic (MC) second twin may exceed that of dichorionic (DC) second twin during vaginal twin delivery. The aim of this study was to investigate the effect of chorionicity on the umbilical artery pH of the second twin in relation to increased twin-to-twin delivery time interval (DTI) from 30 weeks of gestation. A hospital based cohort of all twin deliveries after 30 completed weeks of gestation with the first twin delivered vaginally between 2007 and 2012 in four delivery units in Stockholm county was conducted. The changes of umbilical pH in MC twins compared to DC twins in relation to twin-to-twin DTI was studied using linear regression. The predictors for acidosis (pH 7.10) in the second twin were studied by logistic regression. The cohort included 681 DC and 186 MC twin pairs. There was a correlation between the umbilical pH and the twin-to-twin DTI but independent of the chorionicity, the pH decreased in average by 0.0012 units/min (p < .001). Twin-to twin DTI was a predictor for acidosis of the second twin (p < .01).

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Term twin birth – impact of mode of delivery on outcome

Cited by 34 publications

References 31 publications

Cesarean delivery or induction of labor in pre-labor twin gestations: A secondary analysis of the Twin Birth Study

Cesarean delivery or induction of labor in pre-labor twin gestations: A secondary analysis of the Twin Birth Study

Trends in Caesarean section rates for twin pregnancies: a 20-year cohort study

Short-term outcome of the second twin during vaginal delivery is dependent on delivery time interval but not chorionicity

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