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.