Induction of labor
The clinical decision regarding IOL was made at the discretion of the
attending physician. Induction was performed either by transvaginal
prostaglandin (dinoprostone or misoprostol), intravenous oxytocin
infusion, or a combination of both.18,20-22 Electronic
monitoring of the fetal heart rate was performed continuously. After the
delivery of the first baby, use of ultrasonography was conducted to
check the presentation and heart rate of the second baby. If the second
baby was in the cephalic presentation, we waited for spontaneous
engagement and vaginal delivery with or without the use of vacuum
extraction. If the second baby had a non-reassuring fetal heart rate or
was not in the cephalic presentation, the obstetrician determined the
best delivery method (vacuum extraction, total breech extraction with or
without internal podalic version, or combined intrapartum cesarean
section). The diagnosis of failure to progress or fetal distress and the
subsequent decision for cesarean delivery was made by the attending
physician.