Risk factors for cesarean delivery in twin pregnancies attempting vaginal delivery

• Published in: American journal of obstetrics and gynecology 2015, Vol.212 (1), p.106.e1-106.e5
• Main Authors: Fox, Nathan S., MD, Gupta, Simi, MD, Melka, Stephanie, MD, Silverstein, Michael, MD, Bender, Samuel, MD, Saltzman, Daniel H., MD, Klauser, Chad K., MD, Rebarber, Andrei, MD
• Format: Article
• Language: English
• Subjects: Adult; advanced maternal age; cesarean delivery; Cesarean Section - statistics & numerical data; Delivery, Obstetric; Female; Humans; labor; Labor, Obstetric; nulliparity; Obstetrics and Gynecology; Pregnancy; Pregnancy, Twin; Regression Analysis; Risk Assessment; Risk Factors; twins
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2014.07.056

Objective The purpose of this study was to estimate independent risk factors for cesarean delivery in patients with twin pregnancies who attempt vaginal delivery. Study Design This was an historic cohort of twin pregnancies that were delivered in 1 practice from June 2005 to February 2014. Baseline characteristics were compared between women who delivered vaginally and women who underwent cesarean delivery in labor. Logistic regression analysis was performed to estimate independent risk factors for cesarean delivery. Results Two hundred eighty-six women with twin pregnancies who had attempted vaginal delivery were included in the study. The overall modes of delivery were vaginal delivery (82.2%), cesarean delivery (17.8%), and combined vaginal-cesarean delivery (0%). The most common indication for cesarean delivery in labor was an arrest disorder (82.4%). The risk factors that were associated independently with cesarean delivery were nulliparity (adjusted odds ratio, 5.78; 95% confidence interval, 2.24–14.88) and advanced maternal age of ≥35 years (adjusted odds ratio, 2.36; 95% confidence interval, 1.16–4.80). The patients at highest risk for cesarean delivery (nulliparous, advanced maternal age, induced labor) still had a 48.6% likelihood of vaginal delivery. Conclusion In patients with twin pregnancies who attempt labor, nulliparity and advanced maternal age are associated independently with cesarean delivery in labor. However, even the patients at highest risk for cesarean delivery have nearly a 50% likelihood of successful vaginal delivery and therefore should be allowed to attempt vaginal delivery if it is desired and not otherwise contraindicated.