Pre-labor Cesarean delivery or induction of labor in twin gestation

BACKGROUND: We aimed to compare neonatal and maternal outcomes of twin gestations without spontaneous onset of labor, which underwent induction of labor or pre-labor cesarean section.METHODS: In the Twin Birth Study (TBS), 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. In this secondary analysis of the TBS we focused on the outcomes of the subset of women who did not have a spontaneous onset of labor. 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.RESULTS: Of the 2,804 women included in the TBS, a total of 1,347 (48%) women did not have a spontaneous onset of labor: 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 and induction of labor groups (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 with the first twin in cephalic presentation, induction of labor and pre-labor cesarean section have similar neonatal outcomes. Pre-labor cesarean section is associated with favorable maternal outcomes.