Risk factors for cesarean delivery in twin gestations near term

Objective: We evaluated the risk factors associated with cesarean delivery in laboring twin gestations at least 36 completed weeks. Methods: We reviewed the records of 134 women with twin gestations who underwent a trial of labor between 1993 and 1995. Women who delivered by cesarean were compared with women who delivered vaginally. The factors associated with an increased risk for cesarean were determined using univariate analysis. Logistic regression was used to determine which of those factors was most strongly associated with cesarean delivery. Results: Of 134 laboring twin gestations, 25 (18.7%) delivered by cesarean and 109 (81.3%) delivered vaginally. Univariate analysis revealed that women who delivered by cesarean were more likely to be nulliparous, have a less advanced cervix at both admission and epidural placement, a higher mean oxytocin infusion rate for induction or augmentation of labor, a combined fetal weight greater than 5500 g, and received magnesium for seizure prophylaxis. Multivariate analysis identified that nulliparity and timing of epidural administration were the factors most strongly associated with cesarean delivery. Conclusion: The timing of epidural analgesia is a modifiable risk factor strongly associated with cesarean delivery in term and near-term laboring twin gestations.