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Am J Perinatol
DOI: 10.1055/a-2547-4074
Original Article

Mode of Delivery Outcomes of Induced versus Spontaneous Labor in Individuals with Dichorionic Twins

Manasa G. Rao 
1   Department of Obstetrics and Gynecology, Columbia University Medical Center, New York
2   Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
,
Chelsea A. DeBolt 
2   Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
,
Kelly Wang
3   Department of Population Health Science and Policy, Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, New York
,
Alexandra Mills
2   Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
,
Sonia G. Khurana
4   Department of Obstetrics and Gynecology, New York University, New York, New York
,
Isabelle Band
2   Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
,
Elianna Kaplowitz 
3   Department of Population Health Science and Policy, Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, New York
,
Andrei Rebarber
2   Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
,
Nathan S. Fox
2   Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
,
Joanne Stone
2   Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
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Funding None.
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Abstract

Objective

This study aimed to investigate odds of vaginal delivery comparing induced versus spontaneous labor in nulliparas and multiparas with dichorionic twins.

Study Design

A retrospective review of dichorionic twin pregnancies from 2008 to 2021. Those with scheduled or elective cesarean, malpresentation, prior uterine surgery, fetal anomaly, gestational age (GA) at delivery <34 weeks, and multifetal reduction were excluded. Nulliparas and multiparas were analyzed separately. The primary outcome was vaginal delivery of both twins. Secondary outcomes included preterm delivery, postpartum hemorrhage, and hypertensive disorders of pregnancy (HDP). Outcomes were compared among induced versus spontaneous labor and assessed using univariable and multivariable logistic regression.

Results

Among 258 nulliparas, 176 (68.2%) were induced, and 82 (31.8%) spontaneously labored. Induced patients were older (p = 0.048), had a higher proportion of intrahepatic cholestasis of pregnancy (IHCP; p = 0.04), HDP (p < 0.0001), and later GA at delivery (p < 0.0001). Patients who spontaneously labored had a higher proportion of preterm delivery at <37 weeks (p < 0.0001) and a higher proportion of at least one twin admitted to the neonatal intensive care unit (p = 0.01). On univariable analysis, induction was associated with decreased likelihood of vaginal delivery of both twins (p = 0.01). However, after adjusting for augmentation, GA at delivery, gestational diabetes, and HDP/chronic hypertension, this was no longer statistically significant (p = 0.14). Among 239 multiparas, 108 (45.2%) were induced, and 131 (54.8%) spontaneously labored. Induced patients had a higher proportion of IHCP (p = 0.02), chronic hypertension (p = 0.02), HDP (p < 0.0001), and later GA at delivery (p < 0.0001). Spontaneous labor patients had higher proportion of preterm delivery at <37 weeks (p < 0.0001). There was no significant difference in odds of vaginal delivery between spontaneous versus induced labor on univariate (p = 0.74) or adjusted analysis after controlling for augmentation, GA at delivery, gestational diabetes and HDP/chronic hypertension (p = 0.40) among multiparas.

Conclusion

Among nulliparas and multiparas with dichorionic twins, induction of labor does not appear to be associated with decreased odds of vaginal delivery.

Key Points

  • Spontaneous labor patients had a higher proportion of preterm delivery <37 weeks.

  • Induction of labor and spontaneous labor had similar odds of vaginal delivery.

  • Induction of labor may be offered as a safe option in delivery counseling of DCDA twins.

Keywords

mode of delivery - dichorionic twins - induction - cesarean delivery - twin pregnancy - vaginal delivery


Publication History

Received: 31 December 2024

Accepted: 26 February 2025

Accepted Manuscript online:
27 February 2025

Article published online:
27 March 2025

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