The effects of labor and delivery on maternal and neonatal outcomes in term twins: A retrospective cohort study

D. J. Wenckus*, W. Gao, M. A. Kominiarek, I. Wilkins

*Corresponding author for this work

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objective To compare maternal and neonatal outcomes in twins undergoing a trial of labor versus pre-labor caesarean. Design Retrospective cohort study. Setting 19 US hospitals from the Consortium on Safe Labor. Population Of 2225 twin sets ≥36 weeks' gestation. Methods Maternal (abruption, estimated blood loss, postpartum haemorrhage, transfusion, chorioamnionitis, hysterectomy, ICU admission, death) and neonatal outcomes (birth injury, 5-minute Apgar <7, NICU admission, RDS, TTN, sepsis, asphyxia, NICU length of stay, death) were compared between the trial of labour and pre-labour caesarean groups with univariate and multivariate logistic and linear regression analyses. Similar analyses were performed for actual delivery modes. Main outcome measures Maternal and neonatal outcomes. Results Among the 2225 twin sets, 1078 had a trial of labour, and 65.9% of those delivered vaginally. There was an increased risk for postpartum haemorrhage [OR 2.5, 95% confidence interval (CI) 1.4-4.5] and blood transfusion (OR 1.9, 95%CI 1.2-3.2) for the trial of labour compared with pre-labour caesarean groups. Birth injury only occurred in the trial of labour group, 1% Twin A, 0.4% Twin B. Both twins had a higher risk of 5-minute Apgar <7 with trial of labour compared to pre-labour caesarean (A: OR 3.9, 95%CI 1.05-14.5; B: OR 3.9, 95%CI 1.3-12.3). Conclusion Term twins undergoing a trial of labour have increased maternal haemorrhage and transfusions along with neonatal birth trauma and lower Apgar scores, but these absolute neonatal occurrences were rare. Trial of labour in twins remains a safe and reasonable option in appropriately selected cases.

Original languageEnglish (US)
Pages (from-to)1137-1144
Number of pages8
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume121
Issue number9
DOIs
StatePublished - Jan 1 2014

Fingerprint

Trial of Labor
Cohort Studies
Retrospective Studies
Mothers
Birth Injuries
Confidence Intervals
Postpartum Hemorrhage
Chorioamnionitis
Apgar Score
Asphyxia
Hysterectomy
Blood Transfusion
Linear Models
Length of Stay
Sepsis
Logistic Models
Regression Analysis
Outcome Assessment (Health Care)
Parturition
Hemorrhage

Keywords

  • caesarean
  • trial of labour
  • twins

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

@article{ae2e68380ae644b18ff02e282dee1123,
title = "The effects of labor and delivery on maternal and neonatal outcomes in term twins: A retrospective cohort study",
abstract = "Objective To compare maternal and neonatal outcomes in twins undergoing a trial of labor versus pre-labor caesarean. Design Retrospective cohort study. Setting 19 US hospitals from the Consortium on Safe Labor. Population Of 2225 twin sets ≥36 weeks' gestation. Methods Maternal (abruption, estimated blood loss, postpartum haemorrhage, transfusion, chorioamnionitis, hysterectomy, ICU admission, death) and neonatal outcomes (birth injury, 5-minute Apgar <7, NICU admission, RDS, TTN, sepsis, asphyxia, NICU length of stay, death) were compared between the trial of labour and pre-labour caesarean groups with univariate and multivariate logistic and linear regression analyses. Similar analyses were performed for actual delivery modes. Main outcome measures Maternal and neonatal outcomes. Results Among the 2225 twin sets, 1078 had a trial of labour, and 65.9{\%} of those delivered vaginally. There was an increased risk for postpartum haemorrhage [OR 2.5, 95{\%} confidence interval (CI) 1.4-4.5] and blood transfusion (OR 1.9, 95{\%}CI 1.2-3.2) for the trial of labour compared with pre-labour caesarean groups. Birth injury only occurred in the trial of labour group, 1{\%} Twin A, 0.4{\%} Twin B. Both twins had a higher risk of 5-minute Apgar <7 with trial of labour compared to pre-labour caesarean (A: OR 3.9, 95{\%}CI 1.05-14.5; B: OR 3.9, 95{\%}CI 1.3-12.3). Conclusion Term twins undergoing a trial of labour have increased maternal haemorrhage and transfusions along with neonatal birth trauma and lower Apgar scores, but these absolute neonatal occurrences were rare. Trial of labour in twins remains a safe and reasonable option in appropriately selected cases.",
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The effects of labor and delivery on maternal and neonatal outcomes in term twins : A retrospective cohort study. / Wenckus, D. J.; Gao, W.; Kominiarek, M. A.; Wilkins, I.

In: BJOG: An International Journal of Obstetrics and Gynaecology, Vol. 121, No. 9, 01.01.2014, p. 1137-1144.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The effects of labor and delivery on maternal and neonatal outcomes in term twins

T2 - A retrospective cohort study

AU - Wenckus, D. J.

AU - Gao, W.

AU - Kominiarek, M. A.

AU - Wilkins, I.

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N2 - Objective To compare maternal and neonatal outcomes in twins undergoing a trial of labor versus pre-labor caesarean. Design Retrospective cohort study. Setting 19 US hospitals from the Consortium on Safe Labor. Population Of 2225 twin sets ≥36 weeks' gestation. Methods Maternal (abruption, estimated blood loss, postpartum haemorrhage, transfusion, chorioamnionitis, hysterectomy, ICU admission, death) and neonatal outcomes (birth injury, 5-minute Apgar <7, NICU admission, RDS, TTN, sepsis, asphyxia, NICU length of stay, death) were compared between the trial of labour and pre-labour caesarean groups with univariate and multivariate logistic and linear regression analyses. Similar analyses were performed for actual delivery modes. Main outcome measures Maternal and neonatal outcomes. Results Among the 2225 twin sets, 1078 had a trial of labour, and 65.9% of those delivered vaginally. There was an increased risk for postpartum haemorrhage [OR 2.5, 95% confidence interval (CI) 1.4-4.5] and blood transfusion (OR 1.9, 95%CI 1.2-3.2) for the trial of labour compared with pre-labour caesarean groups. Birth injury only occurred in the trial of labour group, 1% Twin A, 0.4% Twin B. Both twins had a higher risk of 5-minute Apgar <7 with trial of labour compared to pre-labour caesarean (A: OR 3.9, 95%CI 1.05-14.5; B: OR 3.9, 95%CI 1.3-12.3). Conclusion Term twins undergoing a trial of labour have increased maternal haemorrhage and transfusions along with neonatal birth trauma and lower Apgar scores, but these absolute neonatal occurrences were rare. Trial of labour in twins remains a safe and reasonable option in appropriately selected cases.

AB - Objective To compare maternal and neonatal outcomes in twins undergoing a trial of labor versus pre-labor caesarean. Design Retrospective cohort study. Setting 19 US hospitals from the Consortium on Safe Labor. Population Of 2225 twin sets ≥36 weeks' gestation. Methods Maternal (abruption, estimated blood loss, postpartum haemorrhage, transfusion, chorioamnionitis, hysterectomy, ICU admission, death) and neonatal outcomes (birth injury, 5-minute Apgar <7, NICU admission, RDS, TTN, sepsis, asphyxia, NICU length of stay, death) were compared between the trial of labour and pre-labour caesarean groups with univariate and multivariate logistic and linear regression analyses. Similar analyses were performed for actual delivery modes. Main outcome measures Maternal and neonatal outcomes. Results Among the 2225 twin sets, 1078 had a trial of labour, and 65.9% of those delivered vaginally. There was an increased risk for postpartum haemorrhage [OR 2.5, 95% confidence interval (CI) 1.4-4.5] and blood transfusion (OR 1.9, 95%CI 1.2-3.2) for the trial of labour compared with pre-labour caesarean groups. Birth injury only occurred in the trial of labour group, 1% Twin A, 0.4% Twin B. Both twins had a higher risk of 5-minute Apgar <7 with trial of labour compared to pre-labour caesarean (A: OR 3.9, 95%CI 1.05-14.5; B: OR 3.9, 95%CI 1.3-12.3). Conclusion Term twins undergoing a trial of labour have increased maternal haemorrhage and transfusions along with neonatal birth trauma and lower Apgar scores, but these absolute neonatal occurrences were rare. Trial of labour in twins remains a safe and reasonable option in appropriately selected cases.

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