Outcomes in Trial of Labor after Cesarean Section in Twin Pregnancies [36Q]

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Abstract

INTRODUCTION:

We sought to compare delivery and neonatal outcomes in twin pregnancies undergoing a trial of labor after cesarean section (TOLAC).

METHODS:

This retrospective cohort included 2,013 pregnancies undergoing a TOLAC and compared outcomes of cesarean section (CS) versus vaginal birth after cesarean section (VBAC). Delivery outcomes included unplanned hysterectomy, Apgar score <7 at 5 minutes, NICU admission, transfusion, and assisted ventilation >6 hours. Multivariate regression analyses and chi-squared test were used for statistical comparisons and a p-value of less than 0.05 was used to indicate statistical significance. Age, race, BMI, education, and insurance status were controlled for.

RESULTS:

VBACs were associated with Apgar scores <7 at 5 minutes (OR 3.21; 95% CI 2.31-4.47) and lower NICU admission rate (OR 0.75; 95% CI 0.62-0.90). Unplanned hysterectomy, transfusion, and assisted ventilation >6 hours were not statically significant.

CONCLUSION:

VBACs were associated with a lower Apgar scores and fewer NICU admissions than CS in twin pregnancies undergoing TOLAC.

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