# Twin delivery: does induction of labor make a difference?

## TL;DR

Inducing labor in twin pregnancies increases the chance of cesarean delivery and affects perinatal outcomes, highlighting the need for careful counseling.

## Contribution

The study identifies risk factors for cesarean delivery and long intertwin intervals in twin pregnancies.

## Key findings

- Induction of labor doubled the cesarean delivery rate in twin pregnancies.
- Nulliparity and induction were risk factors for cesarean delivery for both twins.
- An intertwin interval of ≥15 minutes was linked to lower umbilical artery pH in the second twin.

## Abstract

Induction of labor as well as delivery in twin pregnancies bears specific risks. The goal of this study was to analyze the delivery mode in twin pregnancies and influence of induction on the cesarean delivery (CD) rate and perinatal outcome and to identify risk factors for CD and an intertwin interval ≥ 15 min.

This single-center retrospective cohort study analyzed the outcome of 267 twin pregnancies. Inclusion criteria for vaginal delivery in twins are gestational age (GA) > 34 weeks, leading twin in cephalic presentation, estimated weight difference ≤ 500 g and no previous uterine surgery. Women were divided into three groups: 1 = vaginal delivery, 2 = CD for both twins, 3 = emergency CD for second twin. Outcomes were mode of delivery, and influence of induction on the CD rate.

We had 156 women (58%) in group 1, 97 (36%) in 2 and 14 (5%) in 3. Induction of labor was performed in 147 cases and led to a higher CD rate (23% vs. 47%, p < 0.001). Induction of labor and nulliparity were associated with a higher risk for CD for both twins. Risk factors for an intertwin interval of ≥ 15 min were maternal age and weight of the second twin. An intertwin interval of ≥ 15 min was associated with a lower umbilical artery pH in the second twin.

The rate of CD doubled if induction of labor was necessary. These results emphasize on careful patient counseling that includes information about the risks of deliveries in twin pregnancies.