Induction of Labor

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Induction of Labor in Twin Compared
WithSingleton PregnanciesMartina Taylor, MD,
MPH, Andrei Rebarber, MD, Daniel H. Saltzman, MD,
Chad K. Klauser, MD,Ashley S. Roman, MD, MPH, and
Nathan S. Fox, MD

• ITAMAR ZILBERMAN

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• In the United States, most twins are delivered by
  cesarean, and this rate has been increasing. From
  1995 to 2008, the cesarean delivery rate for twin
  births in the United States rose from 53.4 to
  75.0.
• Induction of labor is significantly associated
  with cesarean delivery in singleton pregnancies,
  particularly women who are nulliparous and women
  with an unfavorable cervix.
• However, in regard to twin pregnancies, there are
  far less published data regarding outcomes of
  induced labors.

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OBJECTIVE

• Estimate the likelihood of cesarean delivery and
  length of labor in twin pregnancies undergoing
  induction of labor as compared with singleton
  pregnancies.

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METHODS

• A retrospective cohort study of 100 patients with
  twin pregnancy undergoing induction of labor from
  2005 to 2012.
• The control group was 100 randomly selected
  patients in the same practice with a singleton
  pregnancy undergoing induction of labor over the
  same time period.
• The primary outcome was mode of delivery (vaginal
  or
• cesarean).

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• Exclusion criteria were
• Patients who presented in latent or active labor.
• premature rupture of membranes, who were given
  augmentation.
• patients who presented with contractions and
  some degree of cervical dilation who were
  augmented or induced for this indication.
• For patients who require cervical ripening
• 25 micrograms of vaginal misoprostol every 3 to 4
  hours.
• a transcervical Foley catheter with a 60-mL
  balloon.
• Once the cervix is dilated, amniotomy is
  performed and intravenous oxytocin is
  administered toward a goal of contractions
  approximately every 3 minutes.

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• Indications for induction
• Gestational age
• -40 weeks or greater for singleton.
• -38 weeks or greater for DC.
• -37 weeks or greater for MC.
• 2) Maternal hypertension, diabetes, other
  maternal disease.
• 3) Fetal fetal growth restriction,
  oligohydramnios, intrahepatic cholestasis of
  pregnancy
• 4) Other.
• Indications for cesarean
• 1) Arrest disorders failed induction, arrest of
  labor in any stage of labor
• 2) Fetal indication NRFHR, umbilical cord
  prolapse.

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RESULTS

• The likelihood of cesarean delivery did not
  differ between the groups (19 in twins compared
  with 21 in singletons)
• No difference was found in the median or mean
  length of labor or the indication for cesarean
  delivery between the groups.
• .

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• A multivariable regression analysis was done to
  assess for factors that
• are independently associated with cesarean
  delivery in patients
• undergoing induction of labor
• twin pregnancy was not independently associated
  with cesarean delivery
• The factors independently associated with
  cesarean delivery maternal age- positively
  associated with cesarean delivery
• prior vaginal delivery and cervical
  dilation- negatively associated with cesarean
  delivery.

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CONCLUSION

• Patients with twin pregnancies undergoing
  induction of labor have a similar risk of
  cesarean delivery and a similar length of labor
  as patients with singleton pregnancies undergoing
  induction of labor.
• Although twin pregnancies have an increased risk
  of cesarean delivery overall, it does not appear
  to be the result of labor dysfunction or failed
  induction.

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