Establishment of a scoring system for vaginal delivery of twin pregnancies

To establish a scoring system for vaginal delivery of twin pregnancies.

A retrospective cohort study was carried out on pregnant women carrying twins who were under systematic antenatal care and delivered at the Beijing Obstetrics and Gynecology Hospital from January 2017 to March 2019. Factors associated with the vaginal delivery of twins were compared between research (n = 96 successful vaginal deliveries) and comparison groups (n = 18 intrapartum cesarean deliveries).

Five variables were included in the model. Models were developed and the score for each variable was given according to the multiple-factor regression analysis index and nomogram. The scores were: age of the mother <35 y: 64; no gestational diabetes mellitus (GDM): 100, no insulin application in GDM: 47, and application of insulin: 0; appropriateness of weight gain during pregnancy: 82; parity ≥2: 58; and weight of the second fetus (Fetus2) less than the first (Fetus1): 57. The receiver operating characteristic (ROC) curve was plotted and the area under the curve (AUC) was 0.856 (95% CI: 0.783-0.929), the maximum value of the Youden index was 0.5647, and the corresponding score was 168, which yielded a sensitivity of 80.2% and a specificity of 76.3%.

A scoring system guiding the selection of mode of delivery was established. The total score of the model was 361 and when the score was >168, the success rate of a vaginal delivery increased significantly.