دورية أكاديمية
Characteristics Associated with Trial of Labor among Patients with Twin Pregnancies.
| العنوان: | Characteristics Associated with Trial of Labor among Patients with Twin Pregnancies. |
|---|---|
| المؤلفون: | Cipres, Danielle T., Cowherd, Rachael B., Barry, Olivia H., Chen, Liqi, Yee, Lynn M. |
| المصدر: | American Journal of Perinatology; Aug2024, Vol. 41 Issue 11, p1455-1462, 8p |
| مصطلحات موضوعية: | MEDICAL personnel, DELIVERY (Obstetrics), VAGINA, RESEARCH funding, MULTIPLE pregnancy, MULTIPLE regression analysis, LABOR (Obstetrics), PREGNANT women, RETROSPECTIVE studies, TERTIARY care, MULTIVARIATE analysis, DECISION making, CHILDBIRTH education, LONGITUDINAL method, ODDS ratio, STATISTICS, PARITY (Obstetrics), ATTITUDES of medical personnel, HEALTH facilities, CONFIDENCE intervals, BREECH delivery, PSYCHOSOCIAL factors, PATIENTS' attitudes |
| مستخلص: | Objective This study aimed to identify patient and provider factors associated with undergoing trial of labor (TOL) among eligible patients with twin gestations. Study Design This retrospective cohort study of patients with twin gestations who received care at a large tertiary care center from 2000 to 2016 included individuals with live pregnancies greater than 23 weeks of gestation and cephalic-presenting twin. Patients with a prior uterine scar or contraindication to vaginal delivery were excluded from analyses. Maternal and clinical characteristics were compared among patients who did and did not undergo TOL. Multivariable logistic regression models included characteristics chosen a priori and those with bivariable associations with p < 0.1. Interactions between parity and other significant variables in the primary models were also investigated. Results Among 1,888 eligible patients, 80.7% (N = 1,524) underwent TOL. Those undergoing TOL were more likely to be younger, multiparous, and have a maternal–fetal medicine physician as the delivering provider (p < 0.01). Hypertensive disorders of pregnancy were less prevalent among patients undergoing TOL (20.2 vs. 27.8%, p < 0.01). In multivariable analysis, advanced maternal age (adjusted odds ratio [aOR]: 0.55, 95% confidence interval [CI]: 0.40–0.74) and nulliparity (aOR: 0.36, 95% CI: 0.25–0.52) conferred a lower odds of TOL, while having a maternal–fetal medicine provider (aOR: 2.74, 95% CI: 1.55–4.83) was associated with higher odds. Interaction analyses demonstrated no significant interaction effects between parity and other characteristics. Among those undergoing a TOL, 76.0% (1,158/1,524) had a successful vaginal delivery of both twins, with 48.1% (557/1,158) having breech extraction of the second twin. Conclusion In this cohort of twin gestations with a high frequency of TOL, patient and provider characteristics are associated with attempting vaginal delivery. Variation in provider practices suggests differing skills and comfort with twin vaginal delivery may influence route of delivery decision-making in patients with twins. Keypoints Most patients with twin pregnancies undergoing TOL had successful vaginal deliveries. Having an MFM delivering provider was associated with higher odds of attempting twin TOL. Nulliparity and advanced maternal age were associated with lower odds of twin TOL. [ABSTRACT FROM AUTHOR] |
| Copyright of American Journal of Perinatology is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) | |
| قاعدة البيانات: | Complementary Index |
كن أول من يترك تعليقا!