Labor patterns in twin gestations

Leftwich, Heidi; Zaki, Mary N.; Wilkins, Isabelle; Hibbard, Judith U.

doi:10.1016/j.ajog.2013.06.019

Cited by 14 publications

(11 citation statements)

References 12 publications

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“…Studies on the latency phase in twin gestations are sparse and contradictory. One study reports the latent phase to be shorter in twin gestations compared with singletons [ 24 ], unlike the finding in a recent cohort study, where twin gestations had significantly less cervical dilation at admission [ 1 ]. In singleton gestations, there is data to suggest that latent phase duration is longer in induced compared with spontaneous labour, whereas duration of the active phase is similar [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…Twin gestations have slower labour progress compared to singletons, regardless of parity, and require 1–3 hours more to complete the first stage of labour compared with singletons, according to a study by Leftwich and colleagues [ 1 ]. The authors of the study propose that patience in providers and patients, concerning the time needed to come through the active phase of twin labours, may reduce caesarean deliveries for failure to progress.…”

Section: Discussionmentioning

confidence: 99%

“…The authors of the study propose that patience in providers and patients, concerning the time needed to come through the active phase of twin labours, may reduce caesarean deliveries for failure to progress. Sub analysis of induced labours was not done in that study, although approximately 40 % of labours were induced in both groups and, information on induction method was not described [ 1 ]. The results of the present study indicate that when induced labour reaches the active phase, the progress is comparable to those with a spontaneous labour onset.…”

Section: Discussionmentioning

confidence: 99%

“…Standards established for single gestations may not be applicable to twin gestations, since the circumstances for labour and delivery differ. For example, the progress of active phase labour is slower with twins for both nulli-and multiparous women [ 1 ] and slower labours in twins may be the result of uterine inertia due to an overdistended uterus and/or malpresentations [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Induction of twin pregnancy and the risk of caesarean delivery: a cohort study

Jonsson

2015

BMC Pregnancy Childbirth

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BackgroundComplications are common in twin pregnancies and induction of labour is often indicated. Most methods for induction are used but data on risks related to induction methods are sparse. The aim of this study was to investigate the association between induction of labour and caesarean delivery in twin pregnancies, and to assess the influence of induction method.MethodsCohort study of twin pregnancies ≥ 34 weeks, planned for vaginal delivery, from two University Hospitals in Sweden. Data were collected from medical records during the periods 1994 (Örebro) and 2004 (Uppsala) to 2013. During the study period there were 78,180 live born births and 1,282 were twin births. Women with previous caesarean section were excluded. Induction methods were categorized into amniotomy, oxytocin and cervical ripening (intra cervical Foley catheter or prostaglandin). Adjusted odds ratios (AOR) with 95 % confidence interval (CI) for caesarean section were calculated by logistic regression and were adjusted for parity, maternal age, gestational length, complications to the pregnancy, infant birth weight and year of birth. Spontaneous labour onsets were used as the reference group. The main outcome measure was caesarean section.ResultsIn 462 twin pregnancies, 220 (48 %) had induction of labour and 242 (52 %) a spontaneous labour onset. Amniotomy was performed in 149 (68 %) of these inductions, oxytocin was administered in 11 (5 %) and cervical ripening was used in 60 (27 %). The rate of caesarean sections was 21 % in induced and 12 % in spontaneous labours (p 0.01). The absolute risk of caesarean section following induction was: 15 % with amniotomy; 36 % with oxytocin and 37 % with Foley/prostaglandin. Induction of labour increased the risk of caesarean section by 90 % compared with spontaneous labour onset (AOR 1.9, 95 % CI 1.1-3.5) and, when cervical ripening was used, the risk increased more than two fold (AOR 2.5, 95 % CI 1.2-5.3).ConclusionInduction of labour in twin pregnancies increases the risk of caesarean section compared with spontaneous labour onset, especially if Foley catheter or prostaglandins are required. However, approximately 80 % of induced labours are delivered vaginally.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Induction of twin pregnancy and the risk of caesarean delivery: a cohort study

Jonsson

2015

BMC Pregnancy Childbirth

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“…Establishment of referential labor curves for spontaneous deliveries is necessary for appropriate management of labor progression. Various factors which may affect labor progression and duration included maternal race and age 8 , maternal and fetal body sizes 9 , gestational age at delivery 10 , twin gestations 11 , obstetric anesthesia 12 , oxytocin use 3 , 4 , obstetric complications 3 , 4 , and complicated pregnancies 13 . Obstetric anesthesia and oxytocin use are often considered as optional obstetric interventions during spontaneous deliveries 3 - 13 .…”

Section: Introductionmentioning

confidence: 99%

Cervical Dilatation Curves of Spontaneous Deliveries in Pregnant Japanese Females

Inde¹,

Nakai²,

Sekiguchi³

et al. 2018

Int. J. Med. Sci.

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Background: Although cervical dilatation curves are crucial for appropriate management of labor progression, abnormal labor progression and obstetric interventions were included in previous and widely-used cervical dilatation curves. We aimed to describe the cervical dilatation curves of normal labor progression in pregnant Japanese females without abnormal labor progression and obstetric interventions.Methods: We completed retrospective obstetric record reviews on 3172 pregnant Japanese females (parity = 0, n = 1047; parity = 1, n = 1083; parity ≥ 2, n = 1042), aged 20 to 39 years old at delivery, with pregravid body mass indices of less than 30. All patients underwent spontaneous deliveries with term, singleton, cephalic and live newborns of appropriate-for-gestational age birthweight, without adverse neonatal outcomes. We characterized labor progression patterns by examining the relationship between elapsed times from the full dilatation and cervical dilatation stages, and labor durations by examining the distribution of time intervals from one cervical dilatation stage, to the next, and ultimately to the full dilatation.Results: Fastest cervical changes occurred at 6 cm (primiparas) and 5 cm (multiparas) of dilatation. The 95%tile of labor progression took over 3 hours to progress from 6 cm to 7 cm (primiparas), and over 2 hours to progress from 5 cm to 6 cm (multiparas). The 5%tile of traverse time to the full dilatation, during the active phase, was less than 1 hour (primiparas) and 0.5 hours (multiparas). At the end of the active phase, no deceleration phase was observed.Conclusions: Active labor may not start until 5 cm of dilatation. At the beginning of the active phase, cervical dilatation was slower than previously described. These results may reduce opportunities for obstetric interventions during labor progression.

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The impact of prolonged second stage in twins on perinatal outcomes

Zidan

Saad

Siegler

et al. 2021

Intl J Gynecology & Obste

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Objective To assess the duration of the second stage of labor in twin pregnancies in relation to maternal and neonatal outcomes. Methods A retrospective study between 2014 and 2020. Eligible cases were twin pregnancies that reached the second stage. The pre‐defined groups were based on the total time spent in the second stage of labor; Group 1 (<1 h), group 2 (1–2 h), and group 3 (>2 h), which was considered the prolonged second stage group. Results Among the 439 planned vaginal births, successful vaginal delivery of both twins was achieved in 63.8%. Prolonged second stage was observed in 25.8% (89/345). Nulliparity (odds ratio [OR] 7.72, 95% confidence interval [CI] 4.5–13.4) and use of epidural analgesia (OR 5.45, 95% CI 1.2–24.7), were the only independent variables significantly associated with prolonged second stage. Prolonged second stage was associated with a greater risk of intrapartum cesarean delivery (32.6%, P < 0.001), combined delivery (10.1%, P < 0.001), chorioamnionitis (8.3%, P = 0.006) and a admission to neonatal intensive care unit of at least one of the twins (30.3%, P = 0.02). Conclusion Prolonged second stage of labor affects maternal and fetal outcome in twin pregnancies.

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Labor patterns in twin gestations

Cited by 14 publications

References 12 publications

Induction of twin pregnancy and the risk of caesarean delivery: a cohort study

Induction of twin pregnancy and the risk of caesarean delivery: a cohort study

Cervical Dilatation Curves of Spontaneous Deliveries in Pregnant Japanese Females

The impact of prolonged second stage in twins on perinatal outcomes

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