Induction of labour in twin pregnancies. A prospective cohort study

Abstract

INTRODUCTION. In dichorionic twin pregnancies, the Danish national guidelines recommend induction of labour (IOL) at 38 weeks of gestation. This recommendation is rooted in the heightened risks of caesarean section and perinatal death associated with later gestational ages. Additionally, this procedure demonstrates a rate of successful vaginal delivery well above 60%. However, documentation remains inadequate regarding potential variances in outcomes between induction methods such as amniotomy, prostaglandins and balloon catheter. Therefore, we aimed to address this knowledge gap. METHODS. This was a single-centre cohort study encompassing 921 twin pregnancies between 2007 and 2019 at Lillebaelt University Hospital, Kolding, Denmark. The research database was updated prospectively. RESULTS. Maternal mortality was zero. Perinatal mortality was 100% between weeks 22 and 24, gradually declining to 0% beyond 34 weeks. The overall frequency of caesarean section (planned and emergency) was 35%. Among those who underwent IOL, the rates of emergency caesarean section were 28% (32/114) for amniotomy, 41% (36/87) for prostaglandin and 53% (8/15) for balloon methods. CONCLUSIONS. The notably high rates of caesarean section associated with IOL by prostaglandin or balloon catheter in twin pregnancies warrant consideration when planning IOL.