The impact of prolonged second stage in twins on perinatal outcomes

Abstract

Objective To assess the duration of the second stage of labor in twin pregnancies in relation to maternal and neonatal outcomes. Methods 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 (<1 h), group 2 (1–2 h), and group 3 (>2 h), which was considered the prolonged second stage group. Results 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). Conclusion Prolonged second stage of labor affects maternal and fetal outcome in twin pregnancies.

Twin Pregnancy and Postpartum Haemorrhage: A Systematic Review and Meta-analysis

“…Prevalence of NICU admissions was found to be 36.2% (95% CI: 0.155, 0.570, I 2 = 100%, n = 4957) (Fig. 4D) (20,24,26,34,39). The prevalence of perinatal death was found to be 1.1% (95% CI: 0.002, 0.021, I 2 = 98%, n = 246) (Fig.…”

“…Prevalence of APGAR scores < 7 at 5 minutes was 3.9% (95% CI: 0.016, 0.062, I 2 = 97%, n = 282) (Fig. 4C) (20,23,30,34,38,39). Prevalence of NICU admissions was found to be 36.2% (95% CI: 0.155, 0.570, I 2 = 100%, n = 4957) (Fig.…”

“…After removing duplicates, the articles were screened according to the inclusion and exclusion criteria yielding 398 for full-text review. Finally, 21 studies involving 23,330 pregnant patients met the eligibility criteria and were included in this study (4,(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39). The PRISMA ow chart (Figure S1) illustrates the details of the study selection process.…”

“…PPH was reported in twenty studies (4,(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(37)(38)(39). Incidence of PPH for vaginal delivery and CS was found to be 10.9% (95% CI: -0.017, 0.235, I 2 = 96%, n = 84) and 27.0% (95% CI: 0.180, 0.359, I 2 = 99%, n = 1226) respectively (Figs.…”

“…Eleven studies reported birth weight with a mean weight of 2451.1 ± 499.0 g (4,20,22,23,26,29,30,(33)(34)(35)39). Prevalence of term deliveries and pre-term deliveries was found to be 47.3% (95% CI: -0.073, 1.020, I 2 = 100%, n = 6589) and 23.2% (95% CI: 0.057, 0.408, I 2 = 100%, n = 2977) respectively (Figs.…”