Abstract
Objective
The constantly increasing rate of twin gestations has contributed to the sharp increase in cesarean sections (CS). Induction of labor can serve as an alternative mode of obstetric intervention in these patients. The aims of this study were to determine the safety and efficacy of induction of labor in twin gestations and its association with adverse maternal and neonatal outcome.
Study Design
We conducted a retrospective population based cohort study of twin gestation (n=4605 deliveries) including the following groups: 1) Elective CS (n=1171); 2) spontaneous delivery (n=2762); and 3) Induction of labor (n=672). Since some of the patients were included in more than one pregnancy generalized estimating equation (GEE) regression models were used to adjust for confounding factors.
Results
The rate of labor induction in twin gestations was 14.6% (672/4605). In comparison to the other study groups, the rate of nuliparity was higher in the induction groups (p<0.001), these patients were also more likely to conceive spontaneously, to deliver at term, and to have a lower rate of previous CS (p<0.001 for all comparisons). Induction of labor was successful in 81.1% of the patients (545/672). The rate of labor dystocia was higher in women who had induction than in those with spontaneous labor (p<0.001). The CS rate on both twins was lower in the induction than in the spontaneous labor group (p<0.0001), however, this difference was not significant when CS was performed only on the second twin. In a GEE model, after adjustment for confounding factors, induction of labor in twins was independently associated with a lower risk for CS (OR 0.42; CI 0.31-0.57), while conceiving by assisted reproduction and mal presentation of the first twin independently increased this risk.
Conclusion
In a selected population, Induction of Labor in twin gestations is safe and can contribute to the reduction of cesarean deliveries.
The constantly increasing rate of twin gestations has contributed to the sharp increase in cesarean sections (CS). Induction of labor can serve as an alternative mode of obstetric intervention in these patients. The aims of this study were to determine the safety and efficacy of induction of labor in twin gestations and its association with adverse maternal and neonatal outcome.
Study Design
We conducted a retrospective population based cohort study of twin gestation (n=4605 deliveries) including the following groups: 1) Elective CS (n=1171); 2) spontaneous delivery (n=2762); and 3) Induction of labor (n=672). Since some of the patients were included in more than one pregnancy generalized estimating equation (GEE) regression models were used to adjust for confounding factors.
Results
The rate of labor induction in twin gestations was 14.6% (672/4605). In comparison to the other study groups, the rate of nuliparity was higher in the induction groups (p<0.001), these patients were also more likely to conceive spontaneously, to deliver at term, and to have a lower rate of previous CS (p<0.001 for all comparisons). Induction of labor was successful in 81.1% of the patients (545/672). The rate of labor dystocia was higher in women who had induction than in those with spontaneous labor (p<0.001). The CS rate on both twins was lower in the induction than in the spontaneous labor group (p<0.0001), however, this difference was not significant when CS was performed only on the second twin. In a GEE model, after adjustment for confounding factors, induction of labor in twins was independently associated with a lower risk for CS (OR 0.42; CI 0.31-0.57), while conceiving by assisted reproduction and mal presentation of the first twin independently increased this risk.
Conclusion
In a selected population, Induction of Labor in twin gestations is safe and can contribute to the reduction of cesarean deliveries.
| Original language | English |
|---|---|
| Pages (from-to) | S74-S74 |
| Journal | American Journal of Obstetrics and Gynecology |
| Volume | 208 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 2013 |