[TRIAL OF LABOR AFTER CESAREAN IN TWIN GESTATIONS: DOES IT INCREASE MATERNAL OR NEONATAL COMPLICATIONS?]
Hagit Diamant1, Rania Okby1, Majdi Imterat1
1Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Objectives:
To investigate the rate, success and pregnancy outcome following a trial of labor after cesarean (TOLAC) in twin gestations. Study design: A retrospective study including all twin pregnancies with a single prior cesarean delivery between the years 2006 to 2011 was performed. Women with medical indications for cesarean delivery (CD) were excluded. Maternal and neonatal outcomes were compared between women who delivered by CD to those who underwent TOLAC. Stratified analysis using a multiple logistic regression model was performed to control for confounders.
Results:
During the years 2006-2011, 110 women met the inclusion criteria. Of these, 20% (n=22) underwent a TOLAC. The success rate of vaginal birth after cesarean was 77.2% (n=17). No cases of uterine rupture or dehiscence were noted. No significant difference was documented in neonatal outcome (including pH and Apgar scores) between the TOLAC and the CD group. Fertility treatment was noted as a risk factor for repeated CD (35.2 vs. 4.5%, OR=8.6, 95% CI 1.21-61.3, P=0.005). Using a multivariable analysis, with repeated CD as the outcome variable, controlling for confounders such as maternal age, and gestational age, fertility treatment was an independent risk factor for repeated CD (adjusted OR=5.2, 95% CI 0.01-0.70; P=0.02).
Conclusions:
A TOLAC in twin gestation seems to be a safe option for the mother and newborn. Fertility treatment is an independent risk factor for repeated CD in twins.
