1
|
Barg M, Melamed B, Aviram A, Mei-Dan E, Barrett J, Melamed N. Risk of intrapartum cesarean delivery in twin pregnancies: A retrospective cohort study. Int J Gynaecol Obstet 2024. [PMID: 38654541 DOI: 10.1002/ijgo.15557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/04/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To compare the risk of intrapartum cesarean delivery (CD) between patients with twin and singleton pregnancies undergoing a trial of labor and identify risk factors for intrapartum CD in twin pregnancies. METHODS The present study was a retrospective cohort study of patients with a twin or singleton pregnancy who underwent a trial of labor at ≥340/7 weeks in a single center (2015-2022). The primary outcome was the rate of intrapartum CD. In twin pregnancies, this outcome was limited to CD of both twins. The association of plurality with intrapartum CD was estimated using multivariable Poisson regression. RESULTS A total of 20 754 patients met the study criteria, 669 of whom had a twin pregnancy. Patients with twins had a greater risk of intrapartum CD (of both twins) than those with singleton pregnancies (22.1% vs 15.9%, respectively; aRR 1.38 [95% CI: 1.15-1.66]), primarily due to a greater risk of failure to progress. In addition, 4.1% of the twin pregnancies had a CD for the second twin, resulting in an overall CD rate in twin pregnancies of 26.2%. Variables associated with intrapartum CD in twin pregnancies included nulliparity (aOR 3.50, 95% CI: 2.34-5.25), birthweight discordance >20% (aOR 2.47, 95% CI: 1.27-4.78), and labor induction (aOR 1.64, 95% CI: 1.07-2.53). The rate of intrapartum CD was highest when all three risk factors were present (67% [95% CI: 41%-87%]). CONCLUSION Twin pregnancies are associated with a greater risk of intrapartum CD than singleton pregnancies. Information on the individualized risk of intrapartum CD may be valuable when counseling patients with twins regarding mode of delivery.
Collapse
Affiliation(s)
- Moshe Barg
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Ben Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North York General Hospital, Toronto, Ontario, Canada
| | - Amir Aviram
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Elad Mei-Dan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North York General Hospital, Toronto, Ontario, Canada
| | - Jon Barrett
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Nir Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Rissanen AS, Loukovaara M, Gissler M, Nupponen IK, Nuutila ME, Jernman RM. Mode of delivery of Finnish dichorionic and monochorionic-diamniotic twins: A retrospective observational study including a risk score for intrapartum cesarean birth. Health Sci Rep 2023; 6:e1236. [PMID: 37181664 PMCID: PMC10167911 DOI: 10.1002/hsr2.1236] [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: 01/22/2023] [Revised: 04/06/2023] [Accepted: 04/18/2023] [Indexed: 05/16/2023] Open
Abstract
Background and Aims Trial of labor is considered safe also among twins, yet nearly 50% are born via cesarean section in Finland. While planned cesarean births have declined among twins, intrapartum cesarean deliveries have risen, postulating evaluation of criteria for trial of labor. The objective of this study was to create an outline of the mode of delivery of dichorionic and monochorionic-diamniotic Finnish twins. By evaluating risk factors for intrapartum cesarean delivery (CD), we aimed at creating a risk score for intrapartum cesarean birth for twins. Methods A retrospective observational study based on a cohort of dichorionic and monochorionic-diamniotic twin pregnancies considered as candidates for trial of labor in 2006, 2010, 2014, and 2018 (n = 720) was performed. Differences between parturients with vaginal delivery and intrapartum CD to identify potential risk factors for intrapartum CD were assessed. Logistic regression analysis (n = 707) was used to further define risk score points for recognized risk factors. Results A total of 23.8% (171/720, 95% confidence interval [CI] = 20.7-26.9) of parturients experienced intrapartum CD. Induction of labor, primiparity, fear of childbirth, artificial reproductive technology, higher maternal age, and other than cephalic/cephalic presentation independently associated with intrapartum CD. The achieved total risk score ranged from 0 to 13 points with significantly higher points among the CD group (6.61 vs. 4.42, p < 0.001). Using ≥8 points as a cut-off, 51.4% (56/109) were delivered by intrapartum CD (sensitivity = 33.73%, specificity = 90.20%, positive predictive value = 51.38%, negative predictive value = 81.61%). The total risk score had a fair predictive capability for intrapartum CD (area under the curve = 0.729, 95% CI = 0.685-0.773). Conclusion Fair-level risk stratification could be achieved with higher maternal age, primiparity, induction of labor, artificial reproductive technology, fear of childbirth, and other than cephalic/cephalic presentation increasing the risk. Parturients with low-risk score (0-7 points) appear to be the best candidates for trial of labor with acceptable CD rates in this group (18.4%).
Collapse
Affiliation(s)
- Annu‐Riikka S. Rissanen
- Department of Obstetrics and GynecologyUniversity of HelsinkiHelsinkiFinland
- Department of Obstetrics and GynecologyWelfare District of Päijät‐HämeLahtiFinland
| | - Mikko Loukovaara
- Department of Obstetrics and GynecologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Mika Gissler
- Finnish Institute for Health and WelfareHelsinkiFinland
- Karolinska InstituteStockholm and Region StockholmSweden
| | - Irmeli K. Nupponen
- Children's HospitalUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Mika E. Nuutila
- Department of Obstetrics and GynecologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Riina M. Jernman
- Department of Obstetrics and GynecologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| |
Collapse
|
3
|
Lopian M, Kashani-Ligumsky L, Cohen R, Wiener I, Amir BC, Gold Zamir Y, Many A, Rosen H. Induction of Labor in Twins-Double Trouble? J Clin Med 2023; 12:jcm12052041. [PMID: 36902828 PMCID: PMC10004183 DOI: 10.3390/jcm12052041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVE To determine and compare the safety and efficacy of different methods of induction of labor in twin gestations and their effect on maternal and neonatal outcomes. METHODS A retrospective observational cohort study was conducted at a single university-affiliated medical center. Patients with a twin gestation undergoing induction of labor at >32 + 0 weeks comprised the study group. Outcomes were compared to patients with a twin gestation at >32 + 0 weeks who went into labor spontaneously. The primary outcome was cesarean delivery. Secondary outcomes included operative vaginal delivery, postpartum hemorrhage, uterine rupture, 5 min APGAR < 7, and umbilical artery pH < 7.1. A subgroup analysis comparing outcomes for the induction of labor with oral prostaglandin E1 (PGE1), IV Oxytocin ± artificial rupture of membranes (AROM), and extra-amniotic balloon (EAB)+ IV Oxytocin was performed. Data were analyzed using Fisher's exact test, ANOVA, and chi-square tests. RESULTS 268 patients who underwent induction of labor with a twin gestation comprised the study group. 450 patients with a twin gestation who went into labor spontaneously comprised the control group. There were no clinically significant differences between the groups for maternal age, gestational age, neonatal birthweight, birthweight discordancy, and non-vertex second twin. There were significantly more nulliparas in the study group compared to the control group (23.9% vs. 13.8% p < 0.001). The study group was significantly more likely to undergo a cesarean delivery of at least one twin (12.3% vs. 7.5% OR, 1.7 95% CI 1.04-2.85 p = 0.03). However, there was no significant difference in the rate of operative vaginal delivery (15.3% vs. 19.6% OR, 0.74, 95% CI 0.5-1.1 p = 0.16), PPH (5.2% vs. 6.9% OR, 0.75 95% CI 0.39-1.42 p = 0.37), 5-min APGAR scores < 7 (0% vs. 0.2% OR, 0.99 95%CI 0.99-1.00 p = 0.27), umbilical artery pH < 7.1 (1.5% vs. 1.3% OR, 1.12 95% CI 0.3-4.0), or combined adverse outcome (7.8% vs. 8.7% OR, 0.93 95% CI 0.6-1.4 p = 0.85). Furthermore, there were no significant differences in the rates of cesarean delivery or combined adverse outcomes in patients undergoing induction with oral PGE1 compared to IV Oxytocin ± AROM (13.3% vs. 12.5% OR, 1.1 95% CI 0.4-2.0 p = 1.0) (7% vs. 9.3% OR, 0.77 95% CI 0.5-3.5 p = 0.63 ) or EAB+ IV Oxytocin (13.3% vs. 6.9% OR, 2.1 95% CI 0.1-2.1 p = 0.53) (7% vs. 6.9% OR, 1.4 95% CI 0.15-3.5 p = 0.5) or between patients undergoing induction of labor with IV Oxytocin ± AROM and EAB+ IV Oxytocin (12.5% vs. 6.9% OR, 2.1 95% CI 0.1-2.4 p = 0.52) (9.3% vs. 6.9% OR, 0.98 95% CI 0.2-4.7 p = 0.54). There were no cases of uterine rupture in our study. CONCLUSIONS Induction of labor in twin gestations is associated with a two-fold increased risk of cesarean delivery, although this is not associated with adverse maternal or neonatal outcomes. Furthermore, the method of induction of labor used does not affect the chances of success nor the rate of adverse maternal or neonatal outcomes.
Collapse
Affiliation(s)
- Miriam Lopian
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Bnei Brak 51544, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Correspondence: ; Tel.: +972-58-667-3736
| | - Lior Kashani-Ligumsky
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Bnei Brak 51544, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ronnie Cohen
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Bnei Brak 51544, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Izaak Wiener
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Bat-Chen Amir
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Bnei Brak 51544, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Yael Gold Zamir
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Bnei Brak 51544, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ariel Many
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Bnei Brak 51544, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Hadar Rosen
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Bnei Brak 51544, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| |
Collapse
|
4
|
Mei JY, Mallampati D, Pluym ID, Han CS, Afshar Y. Twin Vaginal Deliveries in Labor Rooms: A Cost-Effectiveness Analysis. Am J Perinatol 2023; 40:290-296. [PMID: 33878770 DOI: 10.1055/s-0041-1727213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Twin vaginal deliveries (VDs) are often performed in the operating room (OR) given the theoretical risk of conversion to cesarean delivery (CD) for the aftercoming twin. We aim to evaluate the cost-effectiveness of performing VDs for twin gestations in the labor and delivery room (LDR) versus OR. STUDY DESIGN We conducted a cost-effectiveness analysis using a decision-analysis model that compared the costs and effectiveness of two strategies of twin deliveries undergoing a trial of labor: (1) intended delivery in the LDR and 2) delivery in the OR. Sensitivity analyses were performed to assess strength and validity of the model. Primary outcome was incremental cost-effectiveness ratio (ICER) defined as cost needed to gain 1 quality-adjusted life year (QALY). RESULTS In the base-case scenario, where 7% of deliveries resulted in conversion to CD for twin B, attempting to deliver twins in the LDR was the most cost-effective strategy. For every QALY gained by delivering in the OR, 243,335 USD would need to be spent (ICER). In univariate sensitivity analyses, the most cost-effective strategy shifted to delivering in the OR when the following was true: (1) probability of successful VD was less than 86%, (2) probability of neonatal morbidity after emergent CD exceeded 3.5%, (3) cost of VD in an LDR exceeded 10,500 USD, (4) cost of CD was less than 10,000 USD, or (5) probability of neonatal death from emergent CD exceeded 2.8%. Assuming a willingness to pay of 100,000 USD per neonatal QALY gained, attempted VD in the LDR was cost effective in 51% of simulations in the Monte Carlo analysis. CONCLUSION Twin VDs in the LDR are cost effective based on current neonatal outcome data, taking into account gestational age and associated morbidity. Further investigation is needed to elucidate impact of cost and outcomes on optimal utilization of resources. KEY POINTS · Cost effectiveness of twin VDs in the LDR versus OR was assessed.. · Twin VDs in the LDR are cost effective based on current neonatal outcome data.. · Attempted VD in the LDR was cost effective in 51% of simulations in the Monte Carlo analysis..
Collapse
Affiliation(s)
- Jenny Y Mei
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
| | - Divya Mallampati
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - Ilina D Pluym
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
| | - Christina S Han
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
| | - Yalda Afshar
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
| |
Collapse
|
5
|
Mikaelsen I, Johansen AN, Tappert C, Eggebø TM. Induction of labor in twin pregnancies - A retrospective cohort study. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 32:100724. [PMID: 35436694 DOI: 10.1016/j.srhc.2022.100724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate outcomes in spontaneous and induced twin deliveries. Secondary aims were to study impact of delivery interval and breech presentation of the first twin. METHODS This retrospective cohort study comprised 354 twin deliveries at a tertiary Norwegian hospital. Spontaneous labor onset and induction of labor were compared in women with planned vaginal delivery and gestational age ≥ 34 weeks. The main outcome was intrapartum cesarean section. Secondary outcomes were umbilical arterial pH and five-minute Apgar scores. RESULTS Among the induced labors, 63/229 (27.5%) women underwent intrapartum cesarean section, compared to 45/125 (36%) in spontaneous labors (P = 0.10). Odds ratio for intrapartum cesarean section in induced labors was 0.65 (95% CI 0.40-1.04) after adjusting for maternal age and parity. Median umbilical arterial pH was significantly lower in the second twins in both spontaneous and induced labors, 7.28 (6.94-7.43) vs. 7.32 (7.16-7.42), and 7.27 (6.90-7.48) vs. 7.29 (7.08-7.45), respectively. pH < 7.00 rarely occurred. Second twins born after a delivery interval > 30 min had a significantly higher frequency of pH < 7.10 than those with a shorter interval, P < 0.01. No significant difference was found in frequency of pH < 7.10 between breech-presenting and cephalic-presenting first twins (P = 0.65). One unexpected intrapartum fetal death occurred after labor induction. CONCLUSION Our results support spontaneous onset and induction of labor as safe. Intrapartum cesarean section rates did not differ significantly between spontaneous and induced labors. Delivery interval > 30 min was associated with a lower pH in the second twin.
Collapse
Affiliation(s)
- Ingrid Mikaelsen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Anine Nikoline Johansen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Christian Tappert
- Departement of Obstetrics, Trondheim University Hospital (St. Olav's Hospital), Trondheim, Norway
| | - Torbjørn Moe Eggebø
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Center for Fetal Medicine, Trondheim University Hospital (St. Olav's Hospital), Trondheim, Norway; Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| |
Collapse
|
6
|
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
|
7
|
Hochler H, Guedalia J, Lipschuetz M, Walfisch A, Yagel S, Guedalia Friedman E, Unger R, Sergienko R, Yoles I, Kabiri D, Cohen SM, Sheiner E. Normal labor curve in twin gestation. Am J Obstet Gynecol 2021; 225:546.e1-546.e11. [PMID: 34363782 DOI: 10.1016/j.ajog.2021.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/12/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Failure to progress is one of the leading indications for cesarean delivery in trials of labor in twin gestations. However, assessment of labor progression in twin labors is managed according to singleton labor curves. OBJECTIVE This study aimed to establish a partogram for twin deliveries that reflects normal and abnormal labor progression and customized labor curves for different subgroups of twin labors. STUDY DESIGN This was a multicenter, retrospective cohort analysis of twin deliveries that were recorded in 3 tertiary medical centers between 2003 and 2017. Eligible parturients were those with twin gestations at ≥34 weeks' gestation with cephalic presentation of the presenting twin and ≥2 cervical examinations during labor. Exclusion criteria were elective cesarean delivery without a trial of labor, major fetal anomalies, and fetal demise. The study group comprised twin gestations, whereas singleton gestations comprised the control group. Statistical analysis was performed using Python 3.7.3 and SPSS, version 27. Categorical variables were analyzed using chi-square tests. Student t test and Mann-Whitney U test were applied to analyze the differences in continuous variables, as appropriate. RESULTS A total of 1375 twin deliveries and 142,659 singleton deliveries met the inclusion criteria. Duration of the active phase of labor was significantly longer in twin labors than in singleton labors in both nulliparous and multiparous parturients; the 95th percentile duration was 2 hours longer in nulliparous twin labors and >3.5 hours longer in multiparous twin labors than in singleton labors. The cervical dilation progression rate was significantly slower in twin deliveries than in singleton deliveries with a mean rate in twin deliveries of 1.89 cm/h (95th percentile, 0.51 cm/h) and a mean rate of 2.48 cm/h (95th percentile, 0.73 cm/h) in singleton deliveries (P<.001). In addition, epidural use further slowed labor progression in twin deliveries. The second stage of labor was also markedly longer in twin deliveries, both in nulliparous and multiparous women (95th percentile, 3.04 vs 2.83 hours, P=.002). CONCLUSION Twin labors are characterized by a slower progression of the active phase and second stage of labor compared with singleton labors in nulliparous and multiparous parturients. Epidural analgesia further slows labor progression in twin labors. Implementation of these findings in clinical management might lower cesarean delivery rates among cases with protracted labor in twin gestations.
Collapse
Affiliation(s)
- Hila Hochler
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel
| | - Joshua Guedalia
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Michal Lipschuetz
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel; The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel
| | - Simcha Yagel
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel.
| | - Efrat Guedalia Friedman
- Ben-Gurion University of the Negev, Be'er Sheva, Israel; Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Ron Unger
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Ruslan Sergienko
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Israel Yoles
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Doron Kabiri
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Ein-Kerem, Jerusalem, Israel
| | - Sarah M Cohen
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| |
Collapse
|
8
|
Zafman KB, Rebarber A, Melka S, Naqvi M, Fox NS. Induction of Labor versus Cesarean Delivery in Twin Pregnancies. Am J Perinatol 2020; 37:1324-1334. [PMID: 31344713 DOI: 10.1055/s-0039-1693695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This study was aimed to compare maternal and neonatal outcomes between women with twin pregnancies who underwent induction of labor with those women who had planned Cesarean delivery (CD). STUDY DESIGN This is a retrospective cohort study of women with twin pregnancies ≥ 24 weeks with an indication for delivery but not in labor. Two groups were examined, women who underwent induction and women who underwent planned CD. Maternal and neonatal outcomes were compared between groups both for deliveries at gestational age ≥ 37 weeks and < 37 weeks. RESULTS A total of 453 patients were included. Overall, 212 (46.8%) women underwent induction and 241 (53.2%) underwent planned CD. Women who underwent induction of labor had a high rate of VD, both in the term and preterm groups (69.8 and 73.6%, respectively). Women who underwent induction of labor had reduced maternal length of stay, neonatal length of stay, and blood loss, without any increase in adverse outcomes. Neonatal ventilation of either twin delivered < 37 weeks was higher in the CD compared with induction group (27.5 vs. 9.4%, p < 0.01), but this was not significant on adjusted odds ratio analysis (aOR = 0.71, 95% CI: 0.19-2.66). CONCLUSION Labor induction in twin gestations have improved maternal outcomes and similar neonatal outcomes compared with planned CD.
Collapse
Affiliation(s)
- Kelly B Zafman
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Andrei Rebarber
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York.,Maternal Fetal Medicine Associates, PLLC, New York, New York
| | - Stephanie Melka
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York.,Maternal Fetal Medicine Associates, PLLC, New York, New York
| | - Mariam Naqvi
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York.,Maternal Fetal Medicine Associates, PLLC, New York, New York
| | - Nathan S Fox
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York.,Maternal Fetal Medicine Associates, PLLC, New York, New York
| |
Collapse
|
9
|
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
|
10
|
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
|
11
|
Razavi AS, Chasen ST, Chambers F, Kalish RB. Induction of labor in twin gestation: can we predict success? J Perinat Med 2018; 46:771-775. [PMID: 29451861 DOI: 10.1515/jpm-2017-0231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 09/13/2017] [Indexed: 11/15/2022]
Abstract
Abstract
Objective:
To identify factors associated with a successful induction of labor in twin pregnancies and associated maternal morbidity.
Study design:
This was a retrospective review of twin pregnancies ≥24 weeks’ gestation undergoing labor induction from 2011 to 2016. The primary outcome was a successful induction of labor. The secondary outcome was a composite of maternal morbidity, including ≥1 of the following: estimated blood loss (EBL) >1500 ml, blood transfusion, hysterectomy, intensive care unit (ICU) admission or maternal death.
Results:
Of 104 twin pregnancies undergoing labor induction, 64 (61.5%) had a vaginal delivery of both twins. Multiparity [odds ratio (OR) 12.3, 95% confidence interval (CI) 3.9–38.8, P≤0.005] and maternal age <35 years (OR 2.33, 95% CI 1.1–5.2, P=0.038) were independently associated with vaginal delivery. The overall rate of composite maternal morbidity was 7.7%. Cesarean delivery (CD) was associated with an increased rate of composite maternal morbidity compared to the successful induction group (17.5% vs. 1.6%, P≤0.005). An EBL >1500 ml, uterine atony and the use of ≥1 uterotonic agent were more frequent in the CD group.
Conclusions:
Multiparous women and those <35 years of age were more likely to have a vaginal delivery. Maternal morbidity is increased in women who required a CD after labor induction compared to those who achieved a vaginal delivery.
Collapse
Affiliation(s)
- Armin S Razavi
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Stephen T Chasen
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Fiona Chambers
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Robin B Kalish
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
12
|
Scapin SQ, Gregório VRP, Collaço VS, Knobel R. INDUÇÃO DE PARTO EM UM HOSPITAL UNIVERSITÁRIO: MÉTODOS E DESFECHOS. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-07072018000710016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: identificar as indicações de indução de trabalho de parto, as práticas utilizadas e os seus desfechos, em um Hospital Universitário do Sul do Brasil. Método: estudo transversal. A população-alvo deste estudo forem 137 mulheres que foram internadas para a indução de trabalho de parto no período de janeiro a outubro de 2014. A análise dos dados foi realizada por meio de análise estatística simples, exploratória, e teste não paramétrico, adotando nível de significância de p≤0,05. Resultados: a maioria (53%) das induções foi realizada por pós-datismo. Quanto aos métodos, destacou-se o uso do Misoprostol de 25mcg via vaginal em 46%, e também o uso do Misoprostol associado à Ocitocina em 28,4%. O Misoprostol foi mais associado a parto vaginal. Conclusão: a indução, caso seja utilizada da maneira correta, é uma importante estratégia para a redução dos altos índices de cesarianas.
Collapse
|
13
|
Melka S, Miller J, Fox NS. Labor and Delivery of Twin Pregnancies. Obstet Gynecol Clin North Am 2017; 44:645-654. [DOI: 10.1016/j.ogc.2017.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
14
|
Mei-Dan E, Asztalos EV, Willan AR, Barrett JFR. The effect of induction method in twin pregnancies: a secondary analysis for the twin birth study. BMC Pregnancy Childbirth 2017; 17:9. [PMID: 28061767 PMCID: PMC5217445 DOI: 10.1186/s12884-016-1201-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 12/16/2016] [Indexed: 11/17/2022] Open
Abstract
Background This secondary analysis for the Twin Birth Study, an international, multicenter trial, aimed to compare the cesarean section rates and safety between methods of induction of labor in twin pregnancies. Methods Women with twin pregnancies where the first twin was in a cephalic presentation and who presented for labor induction, were non-randomly assigned to receive prostaglandin or amniotomy and/or oxytocin. Main outcome measures were the rates of unplanned cesarean section and neonatal and maternal mortality or serious morbidity. Results 153 (41.5%) were induced by prostaglandin (prostaglandin group) and 215 (58.5%) were induced by amniotomy and/or oxytocin alone (no prostaglandin group). Induction using prostaglandin was more common in countries with a low perinatal mortality rate <10/1000 (45.7 versus 32.5%, p = 0.02). Cesarean section rates were similar in the two groups: 62/153 (40.5%) in the prostaglandin group and 87/215 (40.5%) in the no prostaglandin group (odds ratio 1, 95% CI 0.65-1.5). Nulliparity, late maternal age, non-cephalic presentation of twin B and high country’s perinatal mortality rate were found to be independently associated with the induction to end with an unplanned cesarean section. There were no significant differences between groups with respect to maternal or neonatal adverse outcomes. Conclusions The need for cervical ripening by prostaglandin had no effect on the incidence of cesarean delivery or an abnormal outcome. There is a significant risk of unplanned cesarean section independent of chosen induction method. Trial registration This trial was registered at the International Standard Randomized Controlled Trial Register (identifier ISRCTN74420086; December 9, 2003) and retrospectively registered at the www.clinicaltrials.gov (identifier NCT 00187369; September 12, 2005). Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1201-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Elad Mei-Dan
- Women and Babies Program, Sunnybrook Health Sciences Center, Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
| | - Elizabeth V Asztalos
- Women and Babies Program, Sunnybrook Health Sciences Center, Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Andrew R Willan
- Child Health Evaluative Sciences, SickKids Research Institute, University of Toronto, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, ON, Canada
| | - Jon F R Barrett
- Women and Babies Program, Sunnybrook Health Sciences Center, Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| |
Collapse
|
15
|
Tavares MV, Domingues AP, Nunes F, Tavares M, Fonseca E, Moura P. Induction of labour vs. spontaneous vaginal delivery in twin pregnancy after 36 weeks of gestation. J OBSTET GYNAECOL 2016; 37:29-32. [DOI: 10.1080/01443615.2016.1205554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Mariana Vide Tavares
- Obstetric A Department, Coimbra Hospital and University Center, Coimbra, Portugal
| | | | - Filipa Nunes
- Obstetric A Department, Coimbra Hospital and University Center, Coimbra, Portugal
| | - Margarida Tavares
- Obstetric A Department, Coimbra Hospital and University Center, Coimbra, Portugal
| | - Etelvina Fonseca
- Obstetric A Department, Coimbra Hospital and University Center, Coimbra, Portugal
| | - Paulo Moura
- Obstetric A Department, Coimbra Hospital and University Center, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| |
Collapse
|
16
|
Han BR, Park KH, Lee SY, Jung EY, Park JW. Prediction of the risk of cesarean delivery after labor induction in twin gestations based on clinical and ultrasound parameters. J Obstet Gynaecol Res 2016; 42:1125-31. [PMID: 27199212 DOI: 10.1111/jog.13038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 01/11/2016] [Accepted: 04/04/2016] [Indexed: 11/29/2022]
Abstract
AIMS To develop a model based on clinical and ultrasound parameters to predict the risk of cesarean delivery after labor induction in near-term twin gestations. METHODS This retrospective cohort study included 189 consecutive women with twin gestations at ≥ 36.0 weeks scheduled for labor induction. The Bishop score and transvaginal ultrasonographic measurements of cervical length were obtained immediately before labor induction. Parameters studied included maternal age, height, weight, parity, gestational age, Bishop score, cervical length, epidural analgesia, method of conception, chorionicity and birth weight. Prostaglandin E2 (dinoprostone) and oxytocin were used for labor induction. Logistic regression analysis and receiver operating characteristic curve were used to generate a predictive model for cesarean delivery. RESULTS Fifty (26.5%) of the 189 women had cesarean deliveries. According to logistic regression analysis, maternal height (P = 0.004), parity (P = 0.005) and cervical length (P = 0.016), but not Bishop score (P = 0.920), were identified as independent predictors of cesarean delivery. A risk score based on a model of these three parameters was calculated for each patient. The model was shown to have an adequate goodness of fit (P = 0.201) and the area under the curve was 0.722, indicating fairly good discrimination. CONCLUSIONS Maternal height, parity and cervical length were independent parameters for predicting the risk of cesarean delivery after labor induction in twin gestations. A predictive model using these parameters may provide useful information for deciding whether or not to induce labor.
Collapse
Affiliation(s)
- Bo Ryoung Han
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyo Hoon Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Sung Youn Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Young Jung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong Woo Park
- Department of Obstetrics and Gynecology, Inje University College of Medicine, Ilsan-Paik Hospital, Gyeonggi, Korea
| |
Collapse
|
17
|
Hamou B, Wainstock T, Mastrolia SA, Beer-Weisel R, Staretz-Chacham O, Dukler D, Rafaeli-Yehudai T, Mazor M, Erez O. Induction of labor in twin gestation: lessons from a population based study. J Matern Fetal Neonatal Med 2016; 29:3999-4007. [PMID: 26864351 DOI: 10.3109/14767058.2016.1152252] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The route of delivery and the role of induction of labor in twin gestations are controversial. The aim of this study was to determine the efficacy of induction of labor in twin gestations. METHODS This retrospective population based cohort study included 4605 twin gestations divided into following groups: 1) spontaneous parturition (n = 2937, 63.78%); 2) induction of labor (n = 653, 14.2%) and 3) elective cesarean delivery (n = 1015, 22.04%). RESULTS The rate of vaginal delivery in the labor induction group was 81% (529/653). In comparison to the other study groups, induction of labor in twins was independently associated with a 77% reduction in the risk of cesarean delivery (OR 0.23; 95% CI 0.18-0.31) and a 78% reduction in the risk of postpartum death for the second twin (OR 0.22; 95% CI 0.05-0.94). The rate of nulliparity, term delivery and labor dystocia was higher in the induction of labor group (p < 0.001 in all comparisons). CONCLUSIONS Our results suggest that induction of labor in twin gestation is successful and is independently associated with substantial reduction in the risk of cesarean delivery and postpartum death of the second twin.
Collapse
Affiliation(s)
- Batel Hamou
- a Department of Obstetrics and Gynecology , Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev , Beer Sheva , Israel
| | - Tamar Wainstock
- b Department of Epidemiology , Faculty of Health Sciences, Ben Gurion University of the Negev , Beer Sheva , Israel
| | - Salvatore Andrea Mastrolia
- a Department of Obstetrics and Gynecology , Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev , Beer Sheva , Israel .,c Department of Obstetrics and Gynecology , Azienda Ospedaliera Universitaria Policlinico Di Bari, School of Medicine, University of Bari "Aldo Moro" , Bari , Italy
| | - Ruthy Beer-Weisel
- a Department of Obstetrics and Gynecology , Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev , Beer Sheva , Israel
| | - Orna Staretz-Chacham
- d Department of Neonatology , Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev , Beer Sheva , Israel , and
| | - Doron Dukler
- a Department of Obstetrics and Gynecology , Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev , Beer Sheva , Israel
| | - Tal Rafaeli-Yehudai
- a Department of Obstetrics and Gynecology , Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev , Beer Sheva , Israel
| | - Moshe Mazor
- a Department of Obstetrics and Gynecology , Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev , Beer Sheva , Israel
| | - Offer Erez
- e Maternity Department D, Obstetrical Day Care Unit, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev , Beer Sheva , Israel
| |
Collapse
|
18
|
Abstract
Determining the optimal timing for induction of labor is critical in minimizing the risks to maternal and fetal health. While data are available to guide us in some clinical situations, such as hypertension and diabetes, many gaps in knowledge still exist in others, including cholestasis of pregnancy, fetal anomalies, and placental abruption. This review of the currently available literature assesses the risks and benefits of preterm and early term induction in a wide variety of maternal and fetal conditions.
Collapse
Affiliation(s)
- Stephen J Bacak
- Department of Obstetrics and Gynecology, University of Rochester, Elmwood Ave, Box 668, Rochester, NY 14642
| | - Courtney Olson-Chen
- Department of Obstetrics and Gynecology, University of Rochester, Elmwood Ave, Box 668, Rochester, NY 14642
| | - Eva Pressman
- Department of Obstetrics and Gynecology, University of Rochester, Elmwood Ave, Box 668, Rochester, NY 14642.
| |
Collapse
|
19
|
Fox NS, Gupta S, Melka S, Silverstein M, Bender S, Saltzman DH, Klauser CK, Rebarber A. Risk factors for cesarean delivery in twin pregnancies attempting vaginal delivery. Am J Obstet Gynecol 2015; 212:106.e1-5. [PMID: 25088861 DOI: 10.1016/j.ajog.2014.07.056] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 06/15/2014] [Accepted: 07/30/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to estimate independent risk factors for cesarean delivery in patients with twin pregnancies who attempt vaginal delivery. STUDY DESIGN This was an historic cohort of twin pregnancies that were delivered in 1 practice from June 2005 to February 2014. Baseline characteristics were compared between women who delivered vaginally and women who underwent cesarean delivery in labor. Logistic regression analysis was performed to estimate independent risk factors for cesarean delivery. RESULTS Two hundred eighty-six women with twin pregnancies who had attempted vaginal delivery were included in the study. The overall modes of delivery were vaginal delivery (82.2%), cesarean delivery (17.8%), and combined vaginal-cesarean delivery (0%). The most common indication for cesarean delivery in labor was an arrest disorder (82.4%). The risk factors that were associated independently with cesarean delivery were nulliparity (adjusted odds ratio, 5.78; 95% confidence interval, 2.24-14.88) and advanced maternal age of ≥35 years (adjusted odds ratio, 2.36; 95% confidence interval, 1.16-4.80). The patients at highest risk for cesarean delivery (nulliparous, advanced maternal age, induced labor) still had a 48.6% likelihood of vaginal delivery. CONCLUSION In patients with twin pregnancies who attempt labor, nulliparity and advanced maternal age are associated independently with cesarean delivery in labor. However, even the patients at highest risk for cesarean delivery have nearly a 50% likelihood of successful vaginal delivery and therefore should be allowed to attempt vaginal delivery if it is desired and not otherwise contraindicated.
Collapse
Affiliation(s)
- Nathan S Fox
- Maternal Fetal Medicine Associates, PLLC, New York, and the Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Simi Gupta
- Maternal Fetal Medicine Associates, PLLC, New York, and the Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Stephanie Melka
- Maternal Fetal Medicine Associates, PLLC, New York, and the Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael Silverstein
- Maternal Fetal Medicine Associates, PLLC, New York, and the Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Samuel Bender
- Maternal Fetal Medicine Associates, PLLC, New York, and the Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Daniel H Saltzman
- Maternal Fetal Medicine Associates, PLLC, New York, and the Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Chad K Klauser
- Maternal Fetal Medicine Associates, PLLC, New York, and the Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Andrei Rebarber
- Maternal Fetal Medicine Associates, PLLC, New York, and the Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
20
|
Huber G, Schütz H, Seelbach-Göbel B. Induction of labor in twin pregnancies with oral misoprostol versus vaginal dinoprostone--is it effective and safe? J Matern Fetal Neonatal Med 2014; 28:1043-6. [PMID: 25001425 DOI: 10.3109/14767058.2014.942629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare the effectiveness and safety of oral misoprostol versus vaginal dinoprostone for the induction of labor in twin pregnancies. METHODS All twin pregnancies ≥ 34 weeks 0 days that were induced with either misoprostol or dinoprostone in St. Hedwig Hospital between 2002 and 2013 were included in this retrospective study. Length of induction, mode of delivery, maternal and neonatal outcomes were compared between the two groups. RESULTS After identifying 186 twin mothers matching the inclusion criteria, 154 women were induced with misoprostol (group A) and 32 with dinoprostone (group B). There were no differences in demographic data between the groups. Rates of successful vaginal delivery (53.9% versus 56.3%) and length of induction to delivery (30.2 h versus 26.9 h) were also similar. There were slightly higher rates of postpartum hemorrhage in group B (16.6% versus 10.8%), but without reaching statistical significance. Neonatal outcomes regarding umbilical artery pH <7.20 and one minute Apgar also were without significant differences. CONCLUSIONS Study data indicate that oral misoprostol and vaginal dinoprostone are similarly effective and safe for the induction of labor in twin gestations. Further trials with larger series are needed to confirm these results.
Collapse
Affiliation(s)
- Georgine Huber
- Department of Obstetrics and Gynecology, University Regensburg, St. Hedwig Hospital , Regensburg , Germany
| | | | | |
Collapse
|
21
|
Ghassani A, Ghiduci MC, Voglimaci M, Chollet C, Parant O. [Induction of labor in twin pregnancies compared to singleton pregnancies; risk factors for failure]. ACTA ACUST UNITED AC 2014; 44:237-45. [PMID: 24930725 DOI: 10.1016/j.jgyn.2014.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/11/2014] [Accepted: 05/14/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the modalities of induction of labour in twin pregnancies compared with singleton pregnancies and to identify risk factors for failure. MATERIALS ET METHODS A retrospective population-based study was conducted at the Toulouse University Hospital to compare a cohort of diamniotic twin gestations (Twin A in vertex presentation), with induction of labour ≥36 weeks of gestation, between January 2007 and December 2012, to a singleton's cohort that were induced ≥36 weeks of gestation during the 2007 year. One singleton pregnancy was matched for each twin pregnancy with parity and gestational age. RESULTS One hundred and fifty-six twins pregnancies met the inclusion criteria for an induction of labor and were compared to 156 single pregnancies. The same and standard protocol of induction of labor was used for the two cohorts (intrauterine balloon catheter±dinoprostone/ocytocine). The cesarean section rate for failed labor induction (cesarean in latent phase) was similar in the 2 populations (14.7% for twin vs 13.5% for single; P=0.66). The factors associated to failed induction of labor in the total population were nulliparity (OR=1.49) and Bishop score<6 at the beginning of the induction (OR=2.83). CONCLUSION Twin did not appear as risk of failed induction. The protocol for induction of labor in singletons may be safely proposed to twin gestations.
Collapse
Affiliation(s)
- A Ghassani
- Service de gynécologie obstétrique, hôpital Paule-de-Viguier, CHU de Toulouse, 31059 Toulouse cedex 9, France
| | - M-C Ghiduci
- Service de gynécologie obstétrique, hôpital Paule-de-Viguier, CHU de Toulouse, 31059 Toulouse cedex 9, France; UMR1027, Université de Toulouse III, 31073 Toulouse, France
| | - M Voglimaci
- Service de gynécologie obstétrique, hôpital Paule-de-Viguier, CHU de Toulouse, 31059 Toulouse cedex 9, France
| | - C Chollet
- Service de gynécologie obstétrique, hôpital Paule-de-Viguier, CHU de Toulouse, 31059 Toulouse cedex 9, France
| | - O Parant
- Service de gynécologie obstétrique, hôpital Paule-de-Viguier, CHU de Toulouse, 31059 Toulouse cedex 9, France; UMR1027, Université de Toulouse III, 31073 Toulouse, France; Inserm, UMR1027, 31073 Toulouse, France.
| |
Collapse
|
22
|
Lee HC, Blumenfeld YJ. Caesarean delivery for twin gestation at 32-38 weeks does not lead to improved clinical outcomes for neonates or mothers. EVIDENCE-BASED MEDICINE 2013; 19:119. [PMID: 24361755 DOI: 10.1136/eb-2013-101655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Henry C Lee
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Yair J Blumenfeld
- Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
23
|
Okby R, Shoham-Vardi I, Ruslan S, Sheiner E. Is induction of labor risky for twins compare to singleton pregnancies? J Matern Fetal Neonatal Med 2013; 26:1804-6. [PMID: 23662640 DOI: 10.3109/14767058.2013.804047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to investigate whether induction of labor in twin pregnancies is associated with higher rates of maternal complications as compared to singletons. METHOD A retrospective population-based study was conducted to compare maternal complications following induction of labor in twin pregnancies and singletons at Soroka University Medical Center, Be'er-Sheva, Israel, between 1988 and 2010. Stratified analysis using a multiple logistic regression model was performed to control for confounders. RESULTS The study population included 25 913 patients following induction of labor, of these 191 (0.73%) were in twin pregnancies. Induction of labor in twin pregnancies was not associated with adverse maternal outcomes such as cervical tears, third degree perineal tears, uterine rupture, peripartum hysterectomy, post-partum hemorrhage or retained placenta. However, labor induction in twins was significantly associated with cesarean deliveries (31.2% versus 17.1%; p < 0.001). Using a multivariable analysis controlling for confounders, induction at twins was an independent risk factor for cesarean delivery (CD; adjusted OR = 2.2, 95% CI 1.7-2.7, p < 0.001). CONCLUSION Induction of labor in twin pregnancies does not increase the risk for maternal complications. However, it is an independent risk factor for CD.
Collapse
Affiliation(s)
- Rania Okby
- Soroka University Medical Center , Beer Sheva , Israel and
| | | | | | | |
Collapse
|