Induction of labor versus cesarean section after 36 + 0 weeks in twin pregnancy: A review of maternal and neonatal outcomes

INTRODUCTION: Our aim was to assess maternal and perinatal morbidity associated with induction of labor (IOL) and elective cesarean section (ECS) in uncomplicated twin pregnancies delivered >36 weeks' gestation. MATERIAL AND METHODS: A retrospective review of all twin pregnancies, irrespective of chorionicity, that underwent ECS and IOL at the Liverpool Women's Hospital (LWH) over a 10-year period. RESULTS: Three hundred and eighty-two women underwent IOL and 326 had ECS between January 2010 and December 2020 at LWH. 71.2% (n = 272) achieved vaginal delivery of both babies in the IOL group, 4.2% (n = 16) required CS for the second twin. There was no difference in blood loss >1500 mLs (7.4% vs. 6.8%, RR 0.92 (0.54-1.58), p = 0.77). Admission of one or both twins to the neonatal unit was higher following IOL than ECS (13.5% vs. 10%, RR 1.35 (1.01-1.81), p = 0.04 and 5.1% vs. 2.9%, RR 1.75 (1.03-2.97), p = 0.04, respectively). There was no impact of chorionicity on outcomes. CONCLUSIONS: Existing consensus on mode of delivery of twins at term suggests both IOL and ECS are safe options. We found an association between increased neonatal admissions following IOL compared to ECS, which has also been observed in line with previous epidemiological studies. Our study broadens our knowledge and strengthens the case that this should be discussed when counseling women about intended mode of birth.