Twin TOLAC is an independent risk factor for adverse maternal and neonatal outcome

Lopian, Miriam; Kashani-Ligumski, Lior; Cohen, Rony; Assaraf, Sharon; Herzlich, Jacky; Lessing, Joseph B.; Perlman, Sharon

doi:10.1007/s00404-021-06062-2

Cited by 6 publications

(10 citation statements)

References 26 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%

“…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. According to our institution’s policy, we enable women with twin gestation and history of CD to have a trial of labor in almost similar criteria as women with singletons.…”

Section: Discussionmentioning

confidence: 99%

“…Twin TOLAC has largely been associated with a lower rates of successful vaginal delivery than singleton deliveries [ 4 , 5 ]. Although some studies that have shown similar success rates to singleton TOLAC’s [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Although some studies that have shown similar success rates to singleton TOLAC’s [ 6 , 7 ]. The relatively wide range of success rates is due to the various approaches taken by medical centers in when managing twin TOLAC [ 5 , 7 ]. Despite the associated risks, for the appropriate candidates, twins TOLAC is associated with fewer maternal and neonatal complications compared to twin elective CD [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Women undergoing twin TOLAC are considered at greater risk for obstetric complications than singleton TOLAC, such as uterine rupture or adverse perinatal outcomes including perinatal mortality [ 4 , 5 , 9 ]. Conversely, some studies identify the same rates of uterine rupture and other complications in both singleton and twin TOLAC [ 7 ].…”

Section: Introductionmentioning

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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