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CME Credit Offered
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Poster Session 1

(299) Adverse outcomes of the second twin associated with trial of labor in early preterm births

Thursday, January 30, 2025
10:30 AM – 12:30 PM  

    Submitting Author and Presenting Author(s)

  • Moti Gulersen, MD, MSc

    Assistant Professor, Obstetrics and Gynecology
    Sidney Kimmel Medical College of Thomas Jefferson University
    Philadelphia, Pennsylvania, United States

    • Coauthor(s)

  • EL

    Erez Lenchner, PhD

    Biostatistics and Data Management
    New York University Rory Meyers College of Nursing
    New York, New York, United States

  • MT

    Mariella F. Toro, BA

    Sidney Kimmel Medical College at Thomas Jefferson University
    Philadelphia, Pennsylvania, United States

  • BC

    Brooke E. Ciampaglio, BS

    Sidney Kimmel Medical College of Thomas Jefferson University
    Philadelphia, Pennsylvania, United States

  • Huda B. Al-Kouatly, MD

    Thomas Jefferson University Hospital
    Philadelphia, Pennsylvania, United States

  • Rodney A. McLaren, Jr., Jr., MD

    Thomas Jefferson University Hospital
    Philadelphia, Pennsylvania, United States

Objective: The Twin Birth trial demonstrated that there were no differences in neonatal outcomes between twins who had a trial of labor and those who had a planned cesarean delivery. However, twins < 32 weeks were excluded. Therefore, the objective of this study was to evaluate whether a trial of labor is associated with an increased risk of adverse outcomes of the second twin (Twin B) in preterm births < 32 weeks gestation.

Study Design: Retrospective analysis of the United States Centers for Disease Control and Prevention Natality Live Birth Database (2016-2022). All twin live births between 23 0/7-31 6/7 weeks were eligible for inclusion. Pregnancies initiating prenatal care >16 weeks’ gestation, congenital anomalies, and unknown data were excluded. The primary adverse neonatal composite outcome of Twin B was compared between two groups: twin gestations who underwent a trial of labor (TOL) and those who underwent a cesarean delivery without labor (CD). A subgroup analysis of live births between 24 0/7-27 6/7 weeks’ gestation was performed. Multivariable logistic regression was performed to adjust for potential confounders. Data were presented as adjusted odds ratios (aOR) with 95% confidence intervals (CI).

Results: Of the 39,769 twin live births included, 12,397 (31.2%) underwent a TOL. Baseline characteristics compared between the two groups are displayed in Table 1. TOL was associated with an increased risk of composite neonatal adverse outcome of Twin B compared to CD (45.1% vs 36.3%; aOR 1.28, 95% CI 1.22-1.35). The association remained statistically significant in twin live births between 24 0/7-27 6/7 weeks’ gestation (TOL: 49.9% vs. CD: 47.7%; aOR 1.17, 95% 1.07-1.29).

Conclusion: This study suggests that TOL is associated with an increased risk of adverse neonatal outcomes for Twin B in preterm births < 32 weeks of twin gestation. Providers should consider these risks while counselling  this patient population that was excluded from the Twin Birth trial. Future research evaluating outcomes associated with trial of labor in early preterm twins is needed.