Trial of labor of vertex-nonvertex twins following a previous cesarean delivery

Hochler, Hila; Tevet, Aharon; Barg, Moshe; Suissa-Cohen, Yael; Lipschuetz, Michal; Aviram, Amir; Mei‐Dan, Elad; Melamed, Nir; Barrett, Jon; Fox, Nathan S.; Walfisch, Asnat

doi:10.1016/j.ajogmf.2022.100640

Cited by 4 publications

(3 citation statements)

References 16 publications

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“…Whilst it is accepted to deliver diamniotic twin pregnancies at 32 0/7 weeks of gestation or later with a vertex presenting fetus, vaginally, [ 12 , 13 ] twin TOLAC remains to be a medical predicament. Studies show that the rates of successful twin TOLAC fluctuate between centers from 57% to 81.5% [ 5 , 7 , 14 ]. The successful rate of vaginal delivery of twins, particularly when the second twin is non-vertex, is largely dependent on the skill and expertise of obstetricians, the institution’s policy, as well as the maternity population [ 5 ], all of which may vary between medical centers.…”

Section: Discussionmentioning

confidence: 99%

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Factors Associated with Failed Trial of Labor after Cesarean, among Women with Twin Gestation—A Multicenter Retrospective Cohort Study

Peled

Sela

Joseph

et al. 2022

JCM

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Objective: Twin trial of labor after a cesarean section (TOLAC) is associated with a lower success rate of vaginal delivery than singleton TOLAC, and a higher rate of adverse outcomes in comparison to an elective repeat cesarean delivery. This study aims to investigate the factors associated with failed TOLAC, among women with twin gestation. Study design: A multicenter retrospective cohort study was undertaken. All women with twin pregnancies attempting a trial of labor after a previous cesarean in two university-affiliated obstetrical centers, between 2005 and 2021 were included. The study population included women with a twin gestation where twin A presented in the vertex position, a single previous low segment transverse section, and those who were eligible for a vaginal delivery. Labor, maternal, and neonatal characteristics were compared. A univariate analysis was undertaken, followed by multivariate analysis (aORs; [95% CI]). Results: A total of 160 women attempting a twin TOLAC were included. Vaginal birth after cesarean was achieved in 86.3% of these cases. Assisted reproductive technology (ART), the lack of oxytocin use for augmentation during labor, the lack of epidural analgesia, and preterm birth before 34, 32, and 28 gestational weeks were all found to be associated with failed TOLAC. In the multivariate analysis, cervical dilation on admission (aOR 0.6 [0.40–0.82], p < 0.01), no use of oxytocin (aOR 5.2 [1.36–19.73], p = 0.02), gestational age at delivery (aOR 0.8 [0.65–1.00], p = 0.047) and lack of epidural analgesia (aOR 4.5 [1.01–20.16], p = 0.049), were all found to be significantly associated with failed TOLAC. Conclusion: In the investigated population of women with twins undergoing TOLAC, the use of epidural analgesia, the use of oxytocin and increased cervical dilation to the delivery room are associated with a higher rate of vaginal delivery, and may reduce the risk of repeat cesarean delivery.

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Section: Discussionmentioning

confidence: 99%

“…Firstly, due to the small sample size and secondly, because all factors mentioned are pre-determined and uninterruptible. Alternatively, Hochler et al studied 235 cases of twin TOLAC and whether the presentation of the second fetus affects the success rates of twin TOLAC, finding no statistical significant differences [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Failed Trial of Labor after Cesarean, among Women with Twin Gestation—A Multicenter Retrospective Cohort Study

Peled

Sela

Joseph

et al. 2022

JCM

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“…Several studies have evaluated success rates and safety of a TOLAC in twin gestation; there is no unanimity of opinion regarding the success of rates of vaginal delivery. A number of studies have indicated similar success rates compared to TOLAC in singleton pregnancies with an increased risk of complications [ 8 , 9 ], while others found lower success rates [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

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

Dick¹,

Lessans²,

Ginzburg³

et al. 2023

BMC Pregnancy Childbirth

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Background Trial 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. Objective To assess success rates and maternal and neonatal outcomes in women with a twin gestation and a previous cesarean delivery undergoing IOL. Methods A 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. Results There 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. Conclusions IOL 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.

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