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Am J Perinatol 2024; 41(11): 1455-1462
DOI: 10.1055/a-2295-3329
SMFM Fellowship Series Article

Characteristics Associated with Trial of Labor among Patients with Twin Pregnancies

Danielle T. Cipres 
1   Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Rachael B. Cowherd
1   Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
2   Division of Gynecology, Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
,
Olivia H. Barry
1   Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Liqi Chen
3   Department of Preventive Medicine (Biostatistics), Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Lynn M. Yee
1   Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
› Institutsangaben Funding Research reported in this publication was supported, in part, by the National Institutes of Health's National Center for Advancing Translational Sciences, grant number UL1TR001422. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Additionally, this work was supported by unrestricted grants for resident research from the Friends of Prentice and EDW/Biostatistical Support by the Northwestern University Department of Obstetrics and Gynecology.
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Abstract

Objective This study aimed to identify patient and provider factors associated with undergoing trial of labor (TOL) among eligible patients with twin gestations.

Study Design This retrospective cohort study of patients with twin gestations who received care at a large tertiary care center from 2000 to 2016 included individuals with live pregnancies greater than 23 weeks of gestation and cephalic-presenting twin. Patients with a prior uterine scar or contraindication to vaginal delivery were excluded from analyses. Maternal and clinical characteristics were compared among patients who did and did not undergo TOL. Multivariable logistic regression models included characteristics chosen a priori and those with bivariable associations with p < 0.1. Interactions between parity and other significant variables in the primary models were also investigated.

Results Among 1,888 eligible patients, 80.7% (N = 1,524) underwent TOL. Those undergoing TOL were more likely to be younger, multiparous, and have a maternal–fetal medicine physician as the delivering provider (p < 0.01). Hypertensive disorders of pregnancy were less prevalent among patients undergoing TOL (20.2 vs. 27.8%, p < 0.01). In multivariable analysis, advanced maternal age (adjusted odds ratio [aOR]: 0.55, 95% confidence interval [CI]: 0.40–0.74) and nulliparity (aOR: 0.36, 95% CI: 0.25–0.52) conferred a lower odds of TOL, while having a maternal–fetal medicine provider (aOR: 2.74, 95% CI: 1.55–4.83) was associated with higher odds. Interaction analyses demonstrated no significant interaction effects between parity and other characteristics. Among those undergoing a TOL, 76.0% (1,158/1,524) had a successful vaginal delivery of both twins, with 48.1% (557/1,158) having breech extraction of the second twin.

Conclusion In this cohort of twin gestations with a high frequency of TOL, patient and provider characteristics are associated with attempting vaginal delivery. Variation in provider practices suggests differing skills and comfort with twin vaginal delivery may influence route of delivery decision-making in patients with twins.

Keypoints

  • Most patients with twin pregnancies undergoing TOL had successful vaginal deliveries.

  • Having an MFM delivering provider was associated with higher odds of attempting twin TOL.

  • Nulliparity and advanced maternal age were associated with lower odds of twin TOL.

Keywords

breech extraction - delivery route - maternal–fetal medicine - trial of labor - twin pregnancy - vaginal delivery

Note

This abstract was presented as a poster presentation (#541) at the Society for Maternal-Fetal Medicine 41st Annual Pregnancy Meeting, Virtual, January 25–30, 2021.




Publikationsverlauf

Eingereicht: 22. November 2021

Angenommen: 24. März 2024

Accepted Manuscript online:
26. März 2024

Artikel online veröffentlicht:
15. April 2024

© 2024. Thieme. All rights reserved.

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  • References

  • 1 Christopher D, Robinson BK, Peaceman AM. An evidence-based approach to determining route of delivery for twin gestations. Rev Obstet Gynecol 2011; 4 (3-4): 109-116
    PubMedGoogle Scholar
  • 2 Villar J, Carroli G, Zavaleta N. et al; World Health Organization 2005 Global Survey on Maternal and Perinatal Health Research Group. Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study. BMJ 2007; 335 (7628) 1025
    CrossrefPubMedGoogle Scholar
  • 3 Silver RM, Landon MB, Rouse DJ. et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 2006; 107 (06) 1226-1232
    CrossrefPubMedGoogle Scholar
  • 4 Bibbo C, Robinson JN. Management of twins: vaginal or cesarean delivery?. Clin Obstet Gynecol 2015; 58 (02) 294-308
    CrossrefPubMedGoogle Scholar
  • 5 Barrett JF, Hannah ME, Hutton EK. et al; Twin Birth Study Collaborative Group. A randomized trial of planned cesarean or vaginal delivery for twin pregnancy. N Engl J Med 2013; 369 (14) 1295-1305
    CrossrefPubMedGoogle Scholar
  • 6 ACOG Practice Bulletin No. ACOG Practice Bulletin No. 144: multifetal gestations: twin, triplet, and higher-order multifetal pregnancies. Obstet Gynecol 2014; 123 (05) 1118-1132
    CrossrefPubMedGoogle Scholar
  • 7 Osterman MJ, Martin JA. Trends in low-risk cesarean delivery in the United States, 1990-2013. Natl Vital Stat Rep 2014; 63 (06) 1-16
    PubMedGoogle Scholar
  • 8 Betran AP, Torloni MR, Zhang J. et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health 2015; 12: 57
    CrossrefPubMedGoogle Scholar
  • 9 Lee HC, Gould JB, Boscardin WJ, El-Sayed YY, Blumenfeld YJ. Trends in cesarean delivery for twin births in the United States: 1995-2008. Obstet Gynecol 2011; 118 (05) 1095-1101
    CrossrefPubMedGoogle Scholar
  • 10 Bateni ZH, Clark SL, Sangi-Haghpeykar H. et al. Trends in the delivery route of twin pregnancies in the United States, 2006-2013. Eur J Obstet Gynecol Reprod Biol 2016; 205: 120-126
    CrossrefPubMedGoogle Scholar
  • 11 Srinivas SK, Stamilio DM, Stevens EJ, Odibo AO, Peipert JF, Macones GA. Predicting failure of a vaginal birth attempt after cesarean delivery. Obstet Gynecol 2007; 109 (04) 800-805
    CrossrefPubMedGoogle Scholar
  • 12 Spong CY, Berghella V, Wenstrom KD, Mercer BM, Saade GR. Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol 2012; 120 (05) 1181-1193
    CrossrefPubMedGoogle Scholar
  • 13 Salahuddin M, Mandell DJ, Lakey DL, Eppes CS, Patel DA. Maternal risk factor index and cesarean delivery among women with nulliparous, term, singleton, vertex deliveries, Texas, 2015. Birth 2019; 46 (01) 182-192
    CrossrefPubMedGoogle Scholar
  • 14 Tolcher MC, Holbert MR, Weaver AL. et al. Predicting cesarean delivery after induction of labor among nulliparous women at term. Obstet Gynecol 2015; 126 (05) 1059-1068
    CrossrefPubMedGoogle Scholar
  • 15 Kominiarek MA, Vanveldhuisen P, Hibbard J. et al; Consortium on Safe Labor. The maternal body mass index: a strong association with delivery route. Am J Obstet Gynecol 2010; 203 (03) 264.e1-264.e7
    CrossrefPubMedGoogle Scholar
  • 16 Kawakita T, Reddy UM, Landy HJ, Iqbal SN, Huang CC, Grantz KL. Indications for primary cesarean delivery relative to body mass index. Am J Obstet Gynecol 2016; 215 (04) 515.e1-515.e9
    CrossrefPubMedGoogle Scholar
  • 17 Getahun D, Strickland D, Lawrence JM, Fassett MJ, Koebnick C, Jacobsen SJ. Racial and ethnic disparities in the trends in primary cesarean delivery based on indications. Am J Obstet Gynecol 2009; 201 (04) 422.e1-422.e7
    CrossrefPubMedGoogle Scholar
  • 18 Bryant AS, Washington S, Kuppermann M, Cheng YW, Caughey AB. Quality and equality in obstetric care: racial and ethnic differences in caesarean section delivery rates. Paediatr Perinat Epidemiol 2009; 23 (05) 454-462
    CrossrefPubMedGoogle Scholar
  • 19 Caughey AB, Cahill AG, Guise JM, Rouse DJ. American College of Obstetricians and Gynecologists (College), Society for Maternal-Fetal Medicine. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol 2014; 210 (03) 179-193
    CrossrefPubMedGoogle Scholar
  • 20 Schmitz T, Carnavalet CdeC, Azria E, Lopez E, Cabrol D, Goffinet F. Neonatal outcomes of twin pregnancy according to the planned mode of delivery. Obstet Gynecol 2008; 111 (03) 695-703
    CrossrefPubMedGoogle Scholar
  • 21 Hogle KL, Hutton EK, McBrien KA, Barrett JF, Hannah ME. Cesarean delivery for twins: a systematic review and meta-analysis. Am J Obstet Gynecol 2003; 188 (01) 220-227
    CrossrefPubMedGoogle Scholar
  • 22 Hofmeyr GJ, Barrett JF, Crowther CA. Planned caesarean section for women with a twin pregnancy. Cochrane Database Syst Rev 2015; 2015 (12) CD006553
    PubMedGoogle Scholar
  • 23 Dougan C, Gotha L, Melamed N. et al. Cesarean delivery or induction of labor in pre-labor twin gestations: a secondary analysis of the twin birth study. BMC Pregnancy Childbirth 2020; 20 (01) 702
    CrossrefPubMedGoogle Scholar
  • 24 Mei-Dan E, Dougan C, Melamed N. et al. Planned cesarean or vaginal delivery for women in spontaneous labor with a twin pregnancy: a secondary analysis of the Twin Birth Study. Birth 2019; 46 (01) 193-200
    CrossrefPubMedGoogle Scholar
  • 25 Goossens SM, Ensing S, Roumen FJ, Nijhuis JG, Mol BW. Neonatal outcomes according to actual delivery mode after planned vaginal delivery in women with a twin pregnancy. Eur J Obstet Gynecol Reprod Biol 2021; 256: 17-24
    CrossrefPubMedGoogle Scholar
  • 26 Boyle A, Reddy UM, Landy HJ, Huang CC, Driggers RW, Laughon SK. Primary cesarean delivery in the United States. Obstet Gynecol 2013; 122 (01) 33-40
    CrossrefPubMedGoogle Scholar
  • 27 Fox NS, Silverstein M, Bender S, Klauser CK, Saltzman DH, Rebarber A. Active second-stage management in twin pregnancies undergoing planned vaginal delivery in a U.S. population. Obstet Gynecol 2010; 115 (2 Pt 1): 229-233
    CrossrefPubMedGoogle Scholar
  • 28 Aviram A, Lipworth H, Asztalos EV. et al. The worst of both worlds-combined deliveries in twin gestations: a subanalysis of the Twin Birth Study, a randomized, controlled, prospective study. Am J Obstet Gynecol 2019; 221 (04) 353.e1-353.e7
    CrossrefPubMedGoogle Scholar
  • 29 Enengl S, Oppelt P, Enzelsberger SH. et al. Retrospective evaluation of attempted vaginal deliveries in dichorionic twin pregnancies. Arch Gynecol Obstet 2021; 303 (06) 1461-1468
    CrossrefPubMedGoogle Scholar
  • 30 Mo GN, Cheng YW, Caughey AB, Yee LM. Disparities in trial of labor among women with twin gestations in the United States. Am J Perinatol 2023; 40 (02) 214-221
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 31 Yee LM, Costantine MM, Rice MM. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Racial and ethnic differences in utilization of labor management strategies intended to reduce cesarean delivery rates. Obstet Gynecol 2017; 130 (06) 1285-1294
    CrossrefPubMedGoogle Scholar
  • 32 Easter SR, Taouk L, Schulkin J, Robinson JN. Twin vaginal delivery: innovate or abdicate. Am J Obstet Gynecol 2017; 216 (05) 484-488.e4
    CrossrefPubMedGoogle Scholar
  • 33 Panelli DM, Easter SR, Bibbo C, Robinson JN, Carusi DA. Clinical factors associated with presentation change of the second twin after vaginal delivery of the first twin. Obstet Gynecol 2017; 130 (05) 1104-1111
    CrossrefPubMedGoogle Scholar
  • 34 Easter SR, Lieberman E, Carusi D. Fetal presentation and successful twin vaginal delivery. Am J Obstet Gynecol 2016; 214 (01) 116.e1-116.e10
    CrossrefPubMedGoogle Scholar
  • 35 Birsner ML. A simulator for breech extraction of the second twin. Obstet Gynecol 2018; 131 (06) 1057-1061
    CrossrefPubMedGoogle Scholar
  • 36 Lepage J, Ceccaldi PF, Remini SA, Plaisance P, Voulgaropoulos A, Luton D. Twin vaginal delivery: to maintain skill - simulation is required. Eur J Obstet Gynecol Reprod Biol 2019; 234: 195-199
    CrossrefPubMedGoogle Scholar
  • 37 Rossi AC, Mullin PM, Chmait RH. Neonatal outcomes of twins according to birth order, presentation and mode of delivery: a systematic review and meta-analysis. BJOG 2011; 118 (05) 523-532
    CrossrefPubMedGoogle Scholar
  • 38 Barrett JF, Ritchie WK. Twin delivery. Best Pract Res Clin Obstet Gynaecol 2002; 16 (01) 43-56
    CrossrefPubMedGoogle Scholar
  • 39 Schmitz T, Korb D, Battie C. et al; Jumeaux Mode d'Accouchement study group, Groupe de Recherche en Obstétrique et Gynécologie. Neonatal morbidity associated with vaginal delivery of noncephalic second twins. Am J Obstet Gynecol 2018; 218 (04) 449.e1-449.e13
    CrossrefPubMedGoogle Scholar
  • 40 Lindroos L, Elfvin A, Ladfors L, Wennerholm UB. The effect of twin-to-twin delivery time intervals on neonatal outcome for second twins. BMC Pregnancy Childbirth 2018; 18 (01) 36
    CrossrefPubMedGoogle Scholar
  • 41 Yee LM, Kaimal AJ, Houston KA. et al. Mode of delivery preferences in a diverse population of pregnant women. Am J Obstet Gynecol 2015; 212 (03) 377.e1-377.e24
    CrossrefPubMedGoogle Scholar
  • 42 Murray-Davis B, McVittie J, Barrett JF, Hutton EK. Twin Birth Study Collaborative Group. Exploring women's preferences for the mode of delivery in twin gestations: results of the Twin Birth Study. Birth 2016; 43 (04) 285-292
    CrossrefPubMedGoogle Scholar
  • 43 Garthus-Niegel S, von Soest T, Knoph C, Simonsen TB, Torgersen L, Eberhard-Gran M. The influence of women's preferences and actual mode of delivery on post-traumatic stress symptoms following childbirth: a population-based, longitudinal study. BMC Pregnancy Childbirth 2014; 14: 191
    CrossrefPubMedGoogle Scholar