Affiliation:
1. Department of Obstetrics and Gynecology University of Helsinki Helsinki Finland
2. Department of Obstetrics and Gynecology Welfare District of Päijät‐Häme Lahti Finland
3. Department of Obstetrics and Gynecology University of Helsinki and Helsinki University Hospital Helsinki Finland
4. Finnish Institute for Health and Welfare Helsinki Finland
5. Karolinska Institute Stockholm and Region Stockholm Sweden
6. Children's Hospital University of Helsinki and Helsinki University Hospital Helsinki Finland
Abstract
AbstractBackground and AimsTrial of labor is considered safe also among twins, yet nearly 50% are born via cesarean section in Finland. While planned cesarean births have declined among twins, intrapartum cesarean deliveries have risen, postulating evaluation of criteria for trial of labor. The objective of this study was to create an outline of the mode of delivery of dichorionic and monochorionic‐diamniotic Finnish twins. By evaluating risk factors for intrapartum cesarean delivery (CD), we aimed at creating a risk score for intrapartum cesarean birth for twins.MethodsA retrospective observational study based on a cohort of dichorionic and monochorionic‐diamniotic twin pregnancies considered as candidates for trial of labor in 2006, 2010, 2014, and 2018 (n = 720) was performed. Differences between parturients with vaginal delivery and intrapartum CD to identify potential risk factors for intrapartum CD were assessed. Logistic regression analysis (n = 707) was used to further define risk score points for recognized risk factors.ResultsA total of 23.8% (171/720, 95% confidence interval [CI] = 20.7–26.9) of parturients experienced intrapartum CD. Induction of labor, primiparity, fear of childbirth, artificial reproductive technology, higher maternal age, and other than cephalic/cephalic presentation independently associated with intrapartum CD. The achieved total risk score ranged from 0 to 13 points with significantly higher points among the CD group (6.61 vs. 4.42, p < 0.001). Using ≥8 points as a cut‐off, 51.4% (56/109) were delivered by intrapartum CD (sensitivity = 33.73%, specificity = 90.20%, positive predictive value = 51.38%, negative predictive value = 81.61%). The total risk score had a fair predictive capability for intrapartum CD (area under the curve = 0.729, 95% CI = 0.685–0.773).ConclusionFair‐level risk stratification could be achieved with higher maternal age, primiparity, induction of labor, artificial reproductive technology, fear of childbirth, and other than cephalic/cephalic presentation increasing the risk. Parturients with low‐risk score (0–7 points) appear to be the best candidates for trial of labor with acceptable CD rates in this group (18.4%).