Strengths and limitations
The strength is that this is the first study to develop a prediction
model for cesarean delivery after IOL in twin pregnancies. Some risk
factors that increased cesarean delivery after IOL have been reported in
previous studies.24,28-30 However, we first developed
a prediction model that can estimate the risk of cesarean delivery after
IOL. Another strength of our study is the large sample size. A total of
1,772 twin pregnant women were analyzed. In addition to deriving a
development model for cesarean delivery, we validated the model
internally and externally to interpret the reliability of a model in a
more generalized population.
Nevertheless, the current study has several limitations. Several other
important clinical variables such as Bishop score and cervical length
could not be evaluated as this was a retrospective study, although these
variables might be associated with the risk of cesarean
delivery.24,25 In addition, the current study
population included only Asian, mainly Korean women, and investigated
only two tertiary hospitals. Finally, the current study did not evaluate
maternal and neonatal morbidity and mortality, which are beyond the
scope of the current study. Few previous studies have found that such
outcomes were not significantly different between planned cesarean
delivery and vaginal delivery after IOL in twin
pregnancy.11,14 Further studies are needed to evaluate
the maternal and neonatal outcomes after IOL in twin pregnancies.
Conclusion
A prediction model for cesarean delivery after IOL was created for twin
pregnancies. This model could be used to provide information and
evaluate the risk of cesarean delivery after IOL in twin pregnant women.