Induction of labor versus cesarean section after 36 + 0 weeks in twin pregnancy: A review of maternal and neonatal outcomes.
Induction of labor in uncomplicated twin pregnancies may be associated with higher neonatal admissions compared to elective cesarean section, but both methods are considered safe.
Where it sits
this study against the rest of the carbetocin corpusSummary and findings
This study assessed maternal and perinatal morbidity associated with induction of labor (IOL) and elective cesarean section (ECS) in uncomplicated twin pregnancies delivered after 36 weeks' gestation. A total of 382 women underwent IOL and 326 had ECS. The findings indicated differences in neonatal outcomes between the two delivery methods.
Abstract
Introduction Our aim was to assess maternal and perinatal morbidity associated with induction of labor (IOL) and elective cesarean section (ECS) in uncomplicated twin pregnancies delivered >36 weeks' gestation. Material and methods A retrospective review of all twin pregnancies, irrespective of chorionicity, that underwent ECS and IOL at the Liverpool Women's Hospital (LWH) over a 10-year period. Results Three hundred and eighty-two women underwent IOL and 326 had ECS between January 2010 and December 2020 at LWH. 71.2% (n = 272) achieved vaginal delivery of both babies in the IOL group, 4.2% (n = 16) required CS for the second twin. There was no difference in blood loss >1500 mLs (7.4% vs. 6.8%, RR 0.92 (0.54-1.58), p = 0.77). Admission of one or both twins to the neonatal unit was higher following IOL than ECS (13.5% vs. 10%, RR 1.35 (1.01-1.81), p = 0.04 and 5.1% vs. 2.9%, RR 1.75 (1.03-2.97), p = 0.04, respectively). There was no impact of chorionicity on outcomes. Conclusions Existing consensus on mode of delivery of twins at term suggests both IOL and ECS are safe options. We found an association between increased neonatal admissions following IOL compared to ECS, which has also been observed in line with previous epidemiological studies. Our study broadens our knowledge and strengthens the case that this should be discussed when counseling women about intended mode of birth.
Background
This paper addresses the clinical question of maternal and neonatal outcomes associated with induction of labor versus elective cesarean section in uncomplicated twin pregnancies. Prior studies have suggested that both methods can be safe, but differences in outcomes have not been thoroughly quantified. Understanding these differences is crucial for informed decision-making in obstetric care.
Methods
This was a retrospective review of twin pregnancies at Liverpool Women's Hospital from January 2010 to December 2020. The study included 382 women who underwent IOL and 326 who had ECS. Primary outcomes included rates of vaginal delivery, blood loss, and neonatal unit admissions.
Results
In the IOL group, 71.2% (n=272) achieved vaginal delivery of both babies. Blood loss >1500 mLs occurred in 7.4% of the IOL group compared to 6.8% in the ECS group, with a relative risk of 0.92 (0.54-1.58) and p=0.77. Neonatal admissions were higher in the IOL group, with 13.5% vs. 10% for ECS, RR 1.35 (1.01-1.81), p=0.04.
Interpretation
The findings suggest that while IOL may lead to higher neonatal admissions compared to ECS, the clinical significance of this difference should be carefully evaluated. The effect sizes for blood loss were not clinically meaningful despite being statistically significant. The retrospective nature of the study and potential confounding factors limit the strength of the conclusions.
Key findings
- 71.2% (n=272) achieved vaginal delivery of both babies in the IOL group.
- 4.2% (n=16) required CS for the second twin in the IOL group.
- Blood loss >1500 mLs was 7.4% in IOL vs. 6.8% in ECS, RR 0.92 (0.54-1.58), p=0.77.
- Admission of one or both twins to the neonatal unit was 13.5% in IOL vs. 10% in ECS, RR 1.35 (1.01-1.81), p=0.04.
- 5.1% of twins in the IOL group vs. 2.9% in the ECS group were admitted, RR 1.75 (1.03-2.97), p=0.04.
Limitations
- retrospective design may introduce bias
- potential confounding factors not controlled for
- single-site study limits generalizability
- no long-term follow-up reported