170: Developing a predictive nomogram for twin vaginal delivery: Secondary analysis of the twin birth study

Abstract Background In the Twin Birth Study, women at 320/7–386/7 weeks of gestation, in whom the first twin was in cephalic presentation, were randomized to planned vaginal delivery or cesarean section. The study found no significant differences in neonatal or maternal outcomes in the two planned mode of delivery groups. We aimed to compare neonatal and maternal outcomes of twin gestations without spontaneous onset of labor, who underwent induction of labor or pre-labor cesarean section as the intervention of induction may affect outcomes. Methods In this secondary analysis of the Twin Birth Study we compared those who had an induction of labor with those who had a pre-labor cesarean section. The primary outcome was a composite of fetal or neonatal death or serious neonatal morbidity. Secondary outcome was a composite of maternal morbidity and mortality. Trial Registration: NCT00187369. Results Of the 2804 women included in the Twin Birth Study, a total of 1347 (48%) women required a delivery before a spontaneous onset of labor occurred: 568 (42%) in the planned vaginal delivery arm and 779 (58%) in the planned cesarean arm. Induction of labor was attempted in 409 (30%), and 938 (70%) had a pre-labor cesarean section. The rate of intrapartum cesarean section in the induction of labor group was 41.3%. The rate of the primary outcome was comparable between the pre-labor cesarean section group and induction of labor group (1.65% vs. 1.97%; p = 0.61; OR 0.83; 95% CI 0.43–1.62). The maternal composite outcome was found to be lower with pre-labor cesarean section compared to induction of labor (7.25% vs. 11.25%; p = 0.01; OR 0.61; 95% CI 0.41–0.91). Conclusion In women with twin gestation between 320/7–386/7 weeks of gestation, induction of labor and pre-labor cesarean section have similar neonatal outcomes. Pre-labor cesarean section is associated with favorable maternal outcomes which differs from the overall Twin Birth Study results. These data may be used to better counsel women with twin gestation who are faced with the decision of interventional delivery.

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Planned cesarean or vaginal delivery for women in spontaneous labor with a twin pregnancy: A secondary analysis of the Twin Birth Study

Birth ◽

10.1111/birt.12387 ◽

2018 ◽

Vol 46 (1) ◽

pp. 193-200 ◽

Cited By ~ 4

Author(s):

Elad Mei-Dan ◽

Claire Dougan ◽

Nir Melamed ◽

Elizabeth V. Asztalos ◽

Amir Aviram ◽

...

Keyword(s):

Vaginal Delivery ◽

Twin Pregnancy ◽

Secondary Analysis ◽

Twin Birth

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Cesarean delivery or induction of labor in pre-labor twin gestations: A secondary analysis of the Twin Birth Study

10.21203/rs.3.rs-22890/v2 ◽

2020 ◽

Author(s):

Claire Dougan ◽

Lara Gotha ◽

Nir Melamed ◽

Amir Aviram ◽

Elizabeth Asztalos ◽

...

Keyword(s):

Cesarean Section ◽

Vaginal Delivery ◽

Primary Outcome ◽

Secondary Analysis ◽

Induction Of Labor ◽

Secondary Outcome ◽

Maternal Outcomes ◽

Twin Birth ◽

Study Results ◽

Spontaneous Onset

Abstract Background: In the Twin Birth Study, women at 320/7-386/7 weeks of gestation, in whom the first twin was in cephalic presentation, were randomized to planned vaginal delivery or cesarean section. The study found no significant differences in neonatal or maternal outcomes in the two planned mode of delivery groups. We aimed to compare neonatal and maternal outcomes of twin gestations without spontaneous onset of labor, who underwent induction of labor or pre-labor cesarean section as the intervention of induction may affect outcomes.Methods: In this secondary analysis of the Twin Birth Study we compared those who had an induction of labor with those who had a pre-labor cesarean section. The primary outcome was a composite of fetal or neonatal death or serious neonatal morbidity. Secondary outcome was a composite of maternal morbidity and mortality. Trial Registration: NCT00187369Results: Of the 2,804 women included in the Twin Birth Study, a total of 1,347 (48%) women required a delivery before a spontaneous onset of labor occurred: 568 (42%) in the planned vaginal delivery arm and 779 (58%) in the planned cesarean arm. Induction of labor was attempted in 409 (30%), and 938 (70%) had a pre-labor cesarean section. The rate of intrapartum cesarean section in the induction of labor group was 41.3%. The rate of the primary outcome was comparable between the pre-labor cesarean section group and induction of labor group (1.65% vs. 1.97%; p=0.61; OR 0.83; 95% CI 0.43-1.62). The maternal composite outcome was found to be lower with pre-labor cesarean section compared to induction of labor (7.25% vs. 11.25%; p=0.01; OR 0.61; 95% CI 0.41-0.91). Conclusion:In women with twin gestation between 320/7-386/7 weeks of gestation, induction of labor and pre-labor cesarean section have similar neonatal outcomes. Pre-labor cesarean section is associated with favorable maternal outcomes which differs from the overall Twin Birth Study results. These data may be used to better counsel women with twin gestation who are faced with the decision of interventional delivery.

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The Safety of Low-Dose Aspirin on the Mode of Delivery: Secondary Analysis of the Effect of Aspirin in Gestation and Reproduction Randomized Controlled Trial

American Journal of Perinatology ◽

10.1055/s-0040-1718581 ◽

2020 ◽

Author(s):

Allison A. Eubanks ◽

Carrie J. Nobles ◽

Sunni L. Mumford ◽

Keewan Kim ◽

Micah J. Hill ◽

...

Keyword(s):

Vaginal Delivery ◽

Live Birth ◽

Low Dose ◽

Controlled Trial ◽

Mode Of Delivery ◽

Secondary Analysis ◽

Clinical Effects ◽

Dose Aspirin ◽

Low Dose Aspirin ◽

Intent To Treat

Objective This study aimed to examine whether prenatal low-dose aspirin (LDA) therapy affects risk of cesarean versus vaginal delivery. Study Design This study is a secondary analysis of the randomized clinical effects of aspirin in gestation and reproduction (EAGeR) trial. Women received 81-mg daily aspirin or placebo from preconception to 36 weeks of gestation. Mode of delivery and obstetric complications were abstracted from records. Log-binomial regression models estimated relative risk (RR) of cesarean versus vaginal delivery. Data were analyzed among the total preconception cohort, as well as restricted to women who had a live birth. Results Among 1,228 women, 597 had a live birth. In the intent-to-treat analysis, preconception-initiated LDA was not associated with risk of cesarean (RR = 1.02; 95% confidence interval [CI]: 0.98–1.07) compared with placebo. Findings were similar in just women with a live birth and when accounting prior cesarean delivery and parity. Conclusion Preconception-initiated daily LDA was not associated with mode of delivery among women with one to two prior losses. Key Points

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Spontaneous Labor Onset and Outcomes in Obese Women at Term

American Journal of Perinatology ◽

10.1055/s-0037-1605574 ◽

2017 ◽

Vol 35 (01) ◽

pp. 059-064 ◽

Cited By ~ 4

Author(s):

Judy Wang ◽

Shayna Conner ◽

Methodius Tuuli ◽

George Macones ◽

Candice Woolfolk ◽

...

Keyword(s):

Vaginal Delivery ◽

Retrospective Cohort ◽

Care Center ◽

Tertiary Care ◽

Secondary Analysis ◽

Tertiary Care Center ◽

Obese Women ◽

Gestational Week ◽

Oxytocin Augmentation ◽

Labor Onset

Objective The objective of this study was to compare the rates of spontaneous labor onset and its progression in obese and nonobese women after 37 weeks. Study Design We performed a secondary analysis of a retrospective cohort of all women who were admitted for delivery at ≥ 37 weeks of gestation at a university-based tertiary care center between 2004 and 2010. The cohort was stratified by weeks of gestation at which the patient presented for delivery. The rates of spontaneous labor, vaginal delivery, and augmentation with oxytocin were compared between obese (body mass index [BMI] ≥ 30) and nonobese (BMI < 30) women. Results Obese women had lower rates of spontaneous labor than nonobese women at every gestational week (37 weeks, 6.1 vs. 9.3%, p < 0.001; 38 weeks, 12.8 vs. 19.2%, p < 0.001; 39 weeks 26.0 vs. 37.0%, p < 0.001; 40 weeks, 39.6 vs. 50.2%, p < 0.001; 41 weeks, 30.8 vs. 38.0%, p < 0.012). Among women who presented in spontaneous labor, obesity was associated with higher rates of augmentation with oxytocin and lower rates of vaginal delivery. Conclusion Obese women at or beyond 37 weeks are less likely to experience spontaneous labor compared with nonobese women. In addition, obese women presenting in spontaneous labor are less likely that nonobese women to have a vaginal delivery at 37 to 40 weeks, even after oxytocin augmentation.

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24: Twin birth study: 2-year follow-up of the randomized trial comparing planned cesarean vs planned vaginal delivery for twin pregnancy

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2015.10.047 ◽

2016 ◽

Vol 214 (1) ◽

pp. S18

Author(s):

Elizabeth Asztalos ◽

Mary Hannah ◽

Eileen Hutton ◽

Andrew Willan ◽

Alexander Allen ◽

...

Keyword(s):

Randomized Trial ◽

Vaginal Delivery ◽

Twin Pregnancy ◽

Twin Birth

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Twin birth - planned vaginal delivery still standard of care

Acta Paediatrica ◽

10.1111/apa.13728 ◽

2017 ◽

Vol 106 (6) ◽

pp. 1012-1012

Author(s):

Mikael Norman

Keyword(s):

Vaginal Delivery ◽

Standard Of Care ◽

Twin Birth

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The Influence of Diabetes on Labor Induction with Dinoprostone Vaginal Inserts

American Journal of Perinatology ◽

10.1055/s-0041-1740178 ◽

2021 ◽

Author(s):

Jennifer Y. Duffy ◽

Cindy Chau ◽

Kyle Raymond ◽

Olof Rugarn ◽

Deborah A. Wing

Keyword(s):

Vaginal Delivery ◽

Fetal Heart ◽

Secondary Analysis ◽

Labor Induction ◽

Induction Of Labor ◽

Randomized Controlled ◽

Key Points ◽

Active Labor ◽

Heart Rate Pattern ◽

Time To Onset

Objective The aim of this study was to compare duration of labor induction between diabetic and nondiabetic women receiving dinoprostone vaginal insert (10 mg). Study Design This is a secondary analysis of two large randomized controlled trials using dinoprostone vaginal inserts for labor induction. We compare time to active labor, overall delivery, and vaginal delivery between diabetic and nondiabetic women undergoing induction of labor with a 10-mg dinoprostone vaginal insert. Results Diabetic women receiving dinoprostone vaginal insert had a longer time to onset of active labor, overall delivery, and vaginal delivery than their nondiabetic counterparts. There was no difference in abnormal labor affecting fetal heart rate pattern in diabetic women compared with nondiabetic women. The rates of neonatal hyperbilirubinemia were higher in diabetic women. Conclusion Diabetes may represent an independent factor associated with prolonged induction among women undergoing induction of labor with dinoprostone. Dinoprostone is well tolerated in both diabetic and nondiabetic women. Key Points

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