Introduction
Recent improvement in assisted
reproductive technologies (ART) has led to an increase in the rate of
twin pregnancies.1,2 Compared to singleton
pregnancies, twin pregnancies are at a higher risk for gestational
hypertension, preeclampsia,3,4 intrahepatic
cholestasis,5 and gestational
diabetes.6 Moreover, there is a higher risk of
stillbirth with advancing gestational age even in uncomplicated
twins,3-8, and elective delivery at 37-38 weeks of
gestation is generally recommended.9,10
Regarding the mode of delivery, diamniotic twin pregnancies with the
cephalic presentation of the fetus are candidates for vaginal delivery.
Planned vaginal delivery was shown to have a similar risk of neonatal
mortality/morbidity and maternal morbidity compared to planned cesarean
delivery in uncomplicated twin pregnancies.11 The
American College of Obstetricians and Gynecologists and the Society for
Maternal-Fetal Medicine recommend that women with twin pregnancies with
either cephalic/cephalic twins or cephalic/non-cephalic twins should
undergo counseling to attempt a vaginal delivery.12
Women with twin pregnancies who plan to give birth through vaginal
delivery without labor pain may undergo labor induction for vaginal
delivery. While several reports have shown that induction can be safely
performed without increased risk11,13,14, others have
reported an increased risk.15-19 Therefore, twin
pregnant women should undergo counseling regarding the benefits and
risks of labor induction. The prediction of successful induction is a
clinically important issue. However, there are few studies on the risk
factors for cesarean delivery after IOL in twin pregnancies.
To address this issue, we conducted this study to develop and validate a
prediction model for cesarean delivery after IOL in twin pregnancies.