1
|
Amikam U, Hiersch L, Barrett J, Melamed N. Labour induction in twin pregnancies. Best Pract Res Clin Obstet Gynaecol 2021; 79:55-69. [PMID: 34844886 DOI: 10.1016/j.bpobgyn.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 01/21/2023]
Abstract
Medically-indicated deliveries are common in twin pregnancies given the increased risk of various obstetric complications in twin compared to singleton pregnancies, mainly hypertensive disorders of pregnancy and foetal growth restriction. Due to the unique characteristics of twin pregnancies, the success rates and safety of labour induction may be different than in singleton pregnancies. However, while there are abundant data regarding induction of labour in singleton pregnancies, the efficacy and safety of labour induction in twin pregnancies have been far less studied. In the current manuscript we summarize available data on various aspects of labour induction in twin pregnancies including incidence, success rate, prognostic factors, safety and methods for labour induction in twins. This information may assist healthcare providers in counselling patients with twin pregnancies when labour induction is indicated.
Collapse
Affiliation(s)
- Uri Amikam
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Hiersch
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jon Barrett
- Departments of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Nir Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
| |
Collapse
|
2
|
Dougan C, Gotha L, Melamed N, Aviram A, Asztalos EV, Anabusi S, Willan AR, Barrett J, Mei-Dan E. Cesarean delivery or induction of labor in pre-labor twin gestations: a secondary analysis of the twin birth study. BMC Pregnancy Childbirth 2020; 20:702. [PMID: 33203367 PMCID: PMC7672925 DOI: 10.1186/s12884-020-03369-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/28/2020] [Indexed: 11/20/2022] Open
Abstract
Background In the Twin Birth Study, women at 320/7–386/7 weeks of gestation, in whom the first twin was in cephalic presentation, were randomized to planned vaginal delivery or cesarean section. The study found no significant differences in neonatal or maternal outcomes in the two planned mode of delivery groups. We aimed to compare neonatal and maternal outcomes of twin gestations without spontaneous onset of labor, who underwent induction of labor or pre-labor cesarean section as the intervention of induction may affect outcomes. Methods In this secondary analysis of the Twin Birth Study we compared those who had an induction of labor with those who had a pre-labor cesarean section. The primary outcome was a composite of fetal or neonatal death or serious neonatal morbidity. Secondary outcome was a composite of maternal morbidity and mortality. Trial Registration: NCT00187369. Results Of the 2804 women included in the Twin Birth Study, a total of 1347 (48%) women required a delivery before a spontaneous onset of labor occurred: 568 (42%) in the planned vaginal delivery arm and 779 (58%) in the planned cesarean arm. Induction of labor was attempted in 409 (30%), and 938 (70%) had a pre-labor cesarean section. The rate of intrapartum cesarean section in the induction of labor group was 41.3%. The rate of the primary outcome was comparable between the pre-labor cesarean section group and induction of labor group (1.65% vs. 1.97%; p = 0.61; OR 0.83; 95% CI 0.43–1.62). The maternal composite outcome was found to be lower with pre-labor cesarean section compared to induction of labor (7.25% vs. 11.25%; p = 0.01; OR 0.61; 95% CI 0.41–0.91). Conclusion In women with twin gestation between 320/7–386/7 weeks of gestation, induction of labor and pre-labor cesarean section have similar neonatal outcomes. Pre-labor cesarean section is associated with favorable maternal outcomes which differs from the overall Twin Birth Study results. These data may be used to better counsel women with twin gestation who are faced with the decision of interventional delivery. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-020-03369-x.
Collapse
Affiliation(s)
- C Dougan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and the Department of Newborn & Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Obstetrics and Gynecology, North York General Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - L Gotha
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and the Department of Newborn & Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, ON, Canada
| | - N Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and the Department of Newborn & Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, ON, Canada
| | - A Aviram
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and the Department of Newborn & Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, ON, Canada
| | - E V Asztalos
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and the Department of Newborn & Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, ON, Canada
| | - S Anabusi
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and the Department of Newborn & Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Obstetrics and Gynecology, North York General Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - A R Willan
- University of Toronto, Toronto, ON, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jfr Barrett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and the Department of Newborn & Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, ON, Canada
| | - E Mei-Dan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and the Department of Newborn & Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. .,Department of Obstetrics and Gynecology, North York General Hospital, Toronto, ON, Canada. .,University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
3
|
Zedini C, Bannour R, Bannour I, Bannour B, Jlassi M, Goul L, Khairi H. [Delivery of twin pregnancy and materno-fetal prognosis in a level 3 Tunisian University Center: a retrospective study about 399 cases]. Pan Afr Med J 2020; 36:237. [PMID: 33708328 PMCID: PMC7908314 DOI: 10.11604/pamj.2020.36.237.19179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 01/08/2020] [Indexed: 11/25/2022] Open
Abstract
En dépit des progrès obstétricaux et pédiatriques, les grossesses gémellaires représentent une situation à haut risque aussi bien pour le déroulement de la grossesse que pour l´accouchement et reste encore une situation angoissante pour l´équipe obstétricale. Le but de cette étude était de décrire la pratique des accouchements des grossesses gémellaires au service de gynécologie obstétrique de Sousse, de décrire le pronostic maternel et fœtal et d´analyser les facteurs pouvant l´influencer. Nous avons réalisé une étude descriptive, rétrospective portant sur les accouchements des grossesses gémellaires sur une période de deux ans. Ont été incluses dans l´étude les grossesses gémellaires ayant atteint au moins 28 semaines d´aménorrhée (SA) et les femmes ayants une grossesse gémellaire compliquée d'une mort fœtale in utéro. Ont été exclues les femmes ayant une grossesse gémellaire et ayant accouchés avant 28 SA. Les grossesses bi-choriales bi-amniotiques représentaient 67% des cas, contre seulement 11,5% de grossesses mono-choriales bi-amniotiques et 3% de grossesses mono-choriale mono-amniotique. Nous avons recensé 52 césariennes programmées. Le travail a été spontané dans 304 cas. Il a été déclenché dans 43 cas. Au total 178 parturientes ont accouché par voie basse (44,6%), contre 215 par voie haute (53,9%). Le taux de césarienne pour le deuxième jumeau était de 1,5%. Quand l'accouchement était par voie basse, 19 cas de complications ont été observés (10,7%). Nous avons analysé le score d'Apgar du premier jumeau et du deuxième jumeau en fonction du mode d'accouchement. Il n'y a pas eu de différence statistiquement significative du score d'Apgar entre les deux voies d'accouchement. La morbi-mortalité périnatale est plus importante pour le deuxième jumeau que pour le premier jumeau. La morbidité maternelle en cas d´accouchement par voie basse était supérieur à la morbidité en cas d´accouchement par césarienne. Il n´y a pas de différences significatives dans le score d´Apgar selon que les enfants sont nés par voie basse ou par césarienne.
Collapse
Affiliation(s)
- Chekib Zedini
- Department of Family and Community Medicine, Faculty of Medicine, Sousse, 4000 Sousse, Tunisia.,Faculty of Medicine Ibn Al Jazzar, University of Sousse, Sousse, Tunisia.,Research Laboratory "LR12ES03", 4002 Sousse, Tunisia
| | - Rania Bannour
- Department of Family and Community Medicine, Faculty of Medicine, Sousse, 4000 Sousse, Tunisia.,Faculty of Medicine Ibn Al Jazzar, University of Sousse, Sousse, Tunisia.,Research Laboratory "LR12ES03", 4002 Sousse, Tunisia
| | - Imen Bannour
- Faculty of Medicine Ibn Al Jazzar, University of Sousse, Sousse, Tunisia.,Research Laboratory "LR12ES03", 4002 Sousse, Tunisia.,Department of Gynecology and Obstetrics, University Hospital Farhat Hached, Street Doctor Moreau, 4000 Sousse, Tunisia
| | - Badra Bannour
- Faculty of Medicine Ibn Al Jazzar, University of Sousse, Sousse, Tunisia.,Research Laboratory "LR12ES03", 4002 Sousse, Tunisia.,Department of Gynecology and Obstetrics, University Hospital Farhat Hached, Street Doctor Moreau, 4000 Sousse, Tunisia
| | - Majdi Jlassi
- Faculty of Medicine Ibn Al Jazzar, University of Sousse, Sousse, Tunisia.,Department of Gynecology and Obstetrics, University Hospital Farhat Hached, Street Doctor Moreau, 4000 Sousse, Tunisia
| | - Leila Goul
- Faculty of Medicine Ibn Al Jazzar, University of Sousse, Sousse, Tunisia.,Department of Gynecology and Obstetrics, University Hospital Farhat Hached, Street Doctor Moreau, 4000 Sousse, Tunisia
| | - Hedi Khairi
- Faculty of Medicine Ibn Al Jazzar, University of Sousse, Sousse, Tunisia.,Department of Gynecology and Obstetrics, University Hospital Farhat Hached, Street Doctor Moreau, 4000 Sousse, Tunisia
| |
Collapse
|
4
|
Risk of cesarean after induction of labor in twin compared to singleton pregnancies. Eur J Obstet Gynecol Reprod Biol 2019; 237:68-73. [PMID: 31022655 DOI: 10.1016/j.ejogrb.2019.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/31/2019] [Accepted: 04/05/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the risk of cesarean delivery after induction of labor in twin compared with singleton pregnancies. STUDY DESIGN This retrospective multicenter study compared data from two nationwide prospective cohorts: one of twin pregnancies established from February 2014 through March 2015 (JUMODA cohort), and the other of singleton pregnancies in November and December 2015 (MEDIP cohort). This study includes all women in both cohorts who had labor induced at ≥ 35 weeks of gestation, with a live fetus in cephalic presentation (Twin 1 for the twin pregnancies). Multivariate analyses with multilevel logistic regression models were used to study twin pregnancy as an independent risk factor for cesarean delivery, overall and stratified for parity and Bishop score. RESULTS The outcomes of 1995 twin births after induction of labor were compared to those of 2771 induced singleton births. The cesarean rate differed significantly between the two populations and was higher in twins (23% in twins vs 19.4% in singletons, P = 0.002). After adjustment for factors associated with cesareans, twin pregnancy was independently associated with it (aOR = 1.8, 95% CI 1.4-2.2). CONCLUSION Twin pregnancy appears to be an independent risk factor for cesarean births after induction of labor, but more than three-quarters of inductions culminated in vaginal delivery.
Collapse
|