The Association Between Epidural Labor Analgesia and the Fetal Outcome and Mode of Delivery of the Second Twin: A Nationwide Register-Based Cohort Study in Finland

( Int J Obstet Anesth. 2023;56:103924. https://doi.org/10.1016/j.ijoa.2023.103924) Multiple pregnancies carry heightened risk of maternal and fetal health issues, including mortality, compared with singleton pregnancies. However, the perinatal mortality rate for twins in Finland has declined, with rates dropping to 0.7% for the first twin and 1.2% for the second twin in recent decades. While vaginal birth trials are generally safe for twin pregnancies, there remain challenges, especially during the delivery of the second twin, leading to higher complication rates than in singleton births. Epidural analgesia is often beneficial, facilitating obstetric procedures without additional anesthesia, as recommended by the 2019 UK NICE guidelines for reducing emergency cesarean deliveries for the second twin. Despite its advantages, epidural analgesia also poses risks, such as increased chances of operative vaginal delivery and potentially prolonged labor. This study aimed to explore the correlation between epidural analgesia, second-twin delivery mode, and the health outcomes of the second twin.