P-OBS-MFM-MD-116 Cesarean versus Vaginal Delivery for Women in Spontaneous Labor of Twin Pregnancy: A 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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170: Developing a predictive nomogram for twin vaginal delivery: Secondary analysis of the twin birth study

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2018.11.191 ◽

2019 ◽

Vol 220 (1) ◽

pp. S127-S128

Author(s):

Hannah B. Anastasio ◽

Jordan T. Levine ◽

Amir Aviram ◽

Gabriele Saccone ◽

Alexis Gimovsky ◽

...

Keyword(s):

Vaginal Delivery ◽

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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Spontanpartus bei Monochorialer-Monoamnialer Schwangerschaft mit 35+5 SSW/Vaginal Delivery of Monoamniotic Twin Pregnancy at the 35+5 Week of Pregnancy

10.1055/s-0039-3401184 ◽

2019 ◽

Author(s):

A Horky ◽

A Garcia-Katerna ◽

E Hollatz-Galuschki ◽

F Kainer

Keyword(s):

Vaginal Delivery ◽

Twin Pregnancy

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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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