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Neonatal and maternal outcomes with elective cesarean section compared to induction of labor in twin pregnancies: A prospective cohort study

https://doi.org/10.1016/j.ejogrb.2023.05.026Get rights and content
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Abstract

Objectives

The aim of this study was to compare neonatal and maternal outcomes in twin pregnancies with elective cesarean section (ECS) and induction of labor (IOL) to better inform women during the counselling process.

Materials and methods

We conducted a cohort study including all twin pregnancies referred to the Department of Obstetrics at Kolding University Hospital, Denmark between January 2007 to April 2019 (n = 819). The primary analysis compared maternal and neonatal outcomes in pregnancies planned for IOL with those planned for ECS after week 34. A secondary analysis compared maternal and neonatal outcomes in pregnancies who underwent IOL followed by successful vaginal delivery with outcomes in those who underwent ECS.

Results

Among 587 eligible twin pregnancies, the rates of unplanned CS did not differ between those planned for ECS compared to those planned for IOL (38% vs. 33%; p = 0.27). IOL resulted in successful vaginal delivery in 67% (155/231) of those planned for IOL. Maternal outcomes did not differ between women who were planned for, or received, delivery with either IOL or ECS. Regarding neonatal outcomes, significantly more neonates required treatment with C-PAP in ECS group, than in the IOL group, and a higher median number of maturity days among mothers planned for ECS. However, no other significant difference in neonatal outcomes was observed when comparing successful IOL with successful ECS.

Conclusion

Induction of labor was not associated with worse outcomes compared to elective caesarean section in this large cohort of routinely handled twin pregnancies. In women with twin pregnancies indicated for delivery, who does not go into spontaneous labor, induction of labor is a safe option for both the mothers and their neonates.

Abbreviations

BMI
Body mass index
CS
Cesarean section
ECS
Elective caesarean
IOL
Induction of labor
MoD
mode of delivery
OR
Odds ratio
PROM
Prelabor rupture of membranes

Keywords

Twin pregnancies
Elective cesarean section
Induction of labor
And spontaneous labor

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