Twin gestation: Is induction of labor possible in highly selected cases?

R. E. Mbu, J. Fouedjio, Y. Fouelifack, J. T. Ngo Batta, F. N. Tumasang, S. N. Ako, R. N. Tonye, M. B. Mbu, R. J. I. Leke

Biostatistics and Epidemiology Unit, Ministry of Secondary Education, Yaounde, Cameroon.
Department of Obstetrics and Gynecology, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
Division Department of Obstetrics and Gynecology, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon and the Maternity Unit, Central Hospital, Yaounde, Cameroon.
Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
Maternity Unit, Central Hospital Yaounde, Yaounde, Cameroon.

DOI: 10.4236/ojog.2012.23043                

Abstract

Induction of labor has been in practice for several decades but the decision to induce labor in multifetal gestations has not been accepted by many practitioners in contemporary obstetrics. The aim of this study was to compare maternal and fetal outcomes among women with uncomplicated twin gestations who were induced at term and those who were not. It was a cross-sectional analytic study that lasted ten years, (1^st January 2000 to 31^st December 2009 inclusive) at the maternity of the central hospital, Yaounde, Cameroon. 158 women were enrolled, 79 were induced and 79 went into labor spontaneously. Maternal and fetal outcomes, duration of labor, the prevalence of caesarean section were compared in the two groups. The average age of the women in the groups was 26, 75 ± 3.65 years (range 15 - 41 years). For those who were induced, indication was premature rupture of membranes in 44 (56%) of cases. The characteristics of induced and none induced women were similar, except for the number of antenatal consultations (P ≤ 0.001). There was a significant difference in the duration of labor in the two groups (6 hrs versus 9, 75 hrs; P ≤ 0.001). The overall rate of vaginal delivery in the two groups was 87, 97% (n = 139), 88.87% in the group that was induced versus 86.07% in the group that labor was spontaneous (OR 1, 22; 95% IC 0, 51-2, 92; p ≤ 0.90). With respect to primary outcomes, there were no statistically significant differences between the group that labor was induced and that which labor was spontaneous. The prevalence of caesarean delivery was similar in the two groups (10%, 12% vs 13%, 92%; OR 0%, 7%; 95% IC 0, 27-1, 85; P ≤ 0.50). The main indications for caesarean section were acute fetal distress and failed induction. The first and fifth minute APGAR scores less than 7 in the first twins delivered in the two groups were similar. The 312 children delivered in both arms did not show any complications at birth. However, there were 3 neonatal deaths (1 vs 2). There were no cases of uterine rupture or maternal deaths among the 156 women. Induction of labor may be proposed to women with uncomplicated term twin gestations with specific indications. Induction in these highly selected cases does not impute any additional risks but close monitoring of labor is very necessary.

Keywords

Induction; Twins; Rupture

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Crane, J., Cistron, R., Moutquin, J.-M. and Young, D. (2001) Déclenchement du travail à terme. Journal of Obstetrics and Gynaecology Canada, 23, 729-741.
[2]	Berland, M. (1997) Déclenchement artificiel du travail. Elsevier SAS, Paris.
[3]	Abirached, F., Haddad, B. and Cabrol, D. (2003) Déclen-chement artificiel du travail à terme. In: Cabrol D., Pons J.C., Goffinet F., Eds., Traité d’Obstétrique, Flammarion Médecine-Sciences, Paris, 781-793.
[4]	Howarth, G.R. and Botha, D.J. (2001) Amniotomy plus intravenous oxytocin for induction of labour (Review). The Cochrane Database of Systematic Reviews, Article ID: CD003250.
[5]	Kelly, A.J. and Tan, B.P. (2001) Intravenous oxytocin alone for cervical ripening and induction of labour (Review). The Cochrane Database of Systematic Reviews, 28, 280-281.
[6]	Boulvain, M., Kelly, A.J. and Irion, O. (2008) Intracervical prostaglandins for induction of labour (Review). The Cochrane Database of Systematic Reviews, Article ID: CD006971.
[7]	Philipe, H. J. (1995) Collège national des gynécologues et obstétriciens Francais. Déclenchement de l’accouchement Conférence de Consensus. Elsevier SAS, Paris.
[8]	Goffinet, F., Dreyfus, M., Carbonne, B., Magnin, G. And Cabrol, D. (2003) Enquêtes des pratiques de maturations du col et de déclenchement du travail en France. Journal de Gynécologie Obstetrique et Biologie de la Reproduction, 32, 638-646.
[9]	Suzuki, S., Otsubo, Y., Sawa, R., Yoneyama, Y. and Araki, T. (2000) Clinical trial of induction of labor versus expectant management in twin pregnancy. Gynecologic and Obstetric Investigation, 49, 24-27. doi:10.1159/000010207
[10]	Harle, T., Brun, J.L. and Leng, J.J. (2002) Induction of labor in twin pregnancy after 36 weeks does not increase maternal-fetal morbidity. International Journal of Gynecology & Obstetrics, 77, 15-21. doi:10.1016/S0020-7292(02)00006-1
[11]	Bush, M.C., Csaba, C., Eddleman, K.K. and Saphier, C.J. (2006) Is misoprostol safe for labor induction in twin gestations? Journal of Maternal-Fetal & Neonatal Medicine, 19, 35-38.
[12]	Dodd, J.M. and Crowther, C.A. (2003) Elective delivery of women with a twin pregnancy from 37 weeks’ gestation (Review). Cochrane Database Systematic Reviews, 1, Article ID: CD003582.
[13]	Hawthorne, G., Irgens, L.M. and Lie, R.T. (2000) Outcome of pregnancy in diabetic women in northeast England and in Norway, British Medical Journal, 321, 730-731. doi:10.1136/bmj.321.7263.730
[14]	Minakami, H. and Sato, I. (1996) Reestimating date of delivery in multifetal pregnancies. Journal of the American Medical Association, 275, 1432-1434. doi:10.1001/jama.1996.03530420060037
[15]	Hilder, L., Costeloe, K. and Thilaganathan, B. (1998) Prolonged pregnancy: Evaluating gestations-specific risks of fetal and infant mortality. BJOG: An International Journal of Obstetrics & Gynaecology, 105, 169-173. doi:10.1111/j.1471-0528.1998.tb10047.x
[16]	Goer, H. (2002) Obstretric myths Versus Research Realities: A Guide to the Medical Literature. 5th Edition, Bergin and Garvey, Westport.
[17]	Gucciardo, L., Thoumsin, H. and Foldart, M.J. (1998) Effet de l’induction du travail sur le déroulement de l’accouchement. Revue Medical de Liege, 53, 665-668.
[18]	Tan B.P and Hannah, M.E. (1997) Prostaglandins versus oxytocin for prelabour rupture of membranes at term (Review). The Cochrane Database of Systematic Reviews, Article ID: CD000159.
[19]	Sanchez-Ramos, L. (2002) Expectant management versus labor induction for suspected fetal macrosomia: A systematic review. Obstetrics & Gynecology, 100, 997-1002.
[20]	Gonen, O., Rosen, D.J.D., Dolfin, Z., Kaneti, H.Y., Katzenstein, M. and Regev, R. (1994) Induction of labor versus expectant management in macrosomia: A prospective randomized study. Proceedings of the 14th Congress of Perinatal Medicine, Helsinki.
[21]	Dobson, P.C., Abell and D.A., Beischer, N.A. (1981) Mortality and morbidity of fetal growth retardation. Australian and New Zealand Journal of Obstetrics and Gynaecology, 21, 69-72. doi:10.1111/j.1479-828X.1981.tb00781.x
[22]	Edée, P. (2000) Le déclenchement de convenance: Incidences materno-foetales. Profession Sage Femme, 66, 18-24.
[23]	Abirached, F., Haddad, B. and Cabrol, D. (2003) Déclenchement artificiel du travail à terme. In: Cabrol, D., Pons, J.C. and Goffinet, F., Eds., Traité d’Obstétrique. Flammarion Médecine-Sciences, Paris, 781-793.
[24]	Orhue, A.A.E. (1993) A randomized trial of 45 minutes and 15 minutes incremental oxytocin infusion regimes for the induction of labour in women of high parity. BJOG: An International Journal of Obstetrics & Gynaecology, 100, 126-129. doi:10.1111/j.1471-0528.1993.tb15206.x
[25]	Guerre, P. (1994) L’induction artificielle du travail estelle susceptible d’entrainer un risque foetal? Congrès la programmation systématique de l’accouchement, 19 November 1994, Bordeaux.
[26]	Cabrol, D. (1985) Technique de déclenchement artificiel du travail. 9e journées nationales du collège national des gynécologues et obstétriciens francais. Mise à jour en gynécologie obstétrique. Vigot, Paris, 165-205.
[27]	Boulvain, M., Stan, C. and Irion, O. (2005) Membrane sweeping for induction of labour (Review). The Cochrane Database of Systematic Reviews, Article ID: CD000451.
[28]	Manabe, Y. and Sagawa, N. (1983) Changes in the mechanical forces of cervical distention before and after rupture of the membranes. American Journal of Obstetrics and Gynecology, 147, 667-671.
[29]	Segal, S., Gemer, O., Zohav, E., Siani, M. and Sassoon, E. (1995) Evaluation of breast stimulation for induction of labor in women with a prior caesarean section and in grand multiparas. Acta Obstetricia et Gynecologica Scandinavica, 74, 40-41. doi:10.3109/00016349509009941
[30]	Francis, J.G., Turnbull, A.C. and Thomas, F.F. (1970) Automatic oxytocin infusion equipment for induction of labour. BJOG: An International Journal of Obstetrics & Gynaecology, 77, 594-602. doi:10.1111/j.1471-0528.1970.tb03576.x
[31]	Buchan, P. C. (1979) Pathogenesis of neonatal hyper-bilirubinemie after induction of labor with oxytocin. British Medical Journal, 2, 1255-1257. doi:10.1136/bmj.2.6200.1255
[32]	Chalmers, I., Campbell, H. and Turnbul, A. C. (1975) Use of oxytocin and incidence of neonatal jaundice. British Medical Journal, 2, 116-118. doi:10.1136/bmj.2.5963.116
[33]	Boulvain, M., Kelly, A.J. and Irion, O. (2008) Intracervical prostaglandins for induction of labour (Review). The Cochrane Database of Systematic Reviews, 23, Article ID: CD006971.
[34]	Wing, D.A., Jones, M.M., Rahall, A., Goodwin, T.M. and Paul, R.H. (1995) Comparison of misoprostol and prostaglandin E2 gel for preinduction cervical ripening and labor induction. American Journal of Obstetrics & Gynecology, 172, 1804-1810. doi:10.1016/0002-9378(95)91415-3
[35]	Frydman, A., Lelaidier, C., Baton, C., Fernandez, H., Vial, M. and Bourget, P. (1992) Labour induction in women at term with mifepristone (RU486): A double-blind randomized, placebo controlled study. Obstetrics and Gynecology, 80, 972-975.
[36]	Gilbert, L., Porter, W. and Brown, V.A. (1987) Postpartum haemorrhage: A continuing problem. BJOG: An International Journal of Obstetrics & Gynaecology, 94, 67-71. doi:10.1111/j.1471-0528.1987.tb02255.x
[37]	Lydon-Rochelle, M. (2001) Risk of uterine rupture during labor among women with a prior cesarean delivery. The New England Journal of Medicine, 345, 3-8. doi:10.1056/NEJM200107053450101
[38]	Glasson, E.J. (2004) Perinatal factors and the development of autism: A population study. Archives of General Psychiatry, 61, 618-627. doi:10.1001/archpsyc.61.6.618
[39]	Mutihir, J.T. and Pam, V.C. (2007) Obstetric outcome of twin pregnancies in Jos, Nigeria. Nigerian Journal of Clinical Practice, 10, 15-18.
[40]	Petterson, B., Blair, A., Watson, L. and Stanley, F. (1998) Adverse outcome after multiple pregnancy. Bailliere’s Clinical Obstetrics and Gynaecology, 12, 1-7. doi:10.1016/S0950-3552(98)80036-9
[41]	Kouam, L., Kamdon Moyo, J., Ngassa, P. and Salihu, M. (1998) Outcome of twins delivries at the university teaching Hospital, Yaoundé, Cameroun—A 15 years experience. Journal of Obstetrics and Gynecology, 18, 340-344.
[42]	Leke, R.J. (1987) Outcome of pregnancy and delivery at the central maternity Central Hospital Yaoundé. Annales University des Science de la Santé, 4, 332-300.
[43]	Nasah, B.T. and Drouin, P. (1982) Soins de la mère en milieu tropical. CEPER, Yaoundé, 93-95.
[44]	Friedman, S.A., Schiff, E., Kao, L., Kuint, J. and Sibai, B.M. (1997) Do twins mature earlier than singletons? Results from a matched cohort study. American Journal of Obstetrics & Gynecology, 176, 1193-1199. doi:10.1016/S0002-9378(97)70334-X
[45]	Santema, J.G., Swaak, A.M. and Wallenburg H.C. (1995) Expectant management of twin pregnancy with single fetal death. BJOG: An International Journal of Obstetrics & Gynaecology, 102, 26-30. doi:10.1111/j.1471-0528.1995.tb09021.x
[46]	Senat, M.V., Ancel, P.Y., Bouvier-Colle, M.H. and Breart, G. (1998) How does multiple pregnancy affect maternal mortality and morbidity? Clinical Obstetrics & Gynecology, 41, 79-83. doi:10.1097/00003081-199803000-00013
[47]	Sullivan, C.A., Harkins, D., Seago, D.P., Roberts, W.E. and Morrison, J.C. (1998) Cesarean delivery for the second twin in the vertex-vertex presentation: Operative indications and predictability. Southern Medical Journal, 91, 155-158. doi:10.1097/00007611-199802000-00007