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CME Credit Offered
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Abstract Award
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Poster Session 4

(1105) Trial of Labor After Cesarean in Twin Pregnancies with Two Prior Cesarean Deliveries

Friday, January 31, 2025
4:00 PM – 6:00 PM  

    Submitting Author and Presenting Author(s)

  • May Abiad, MD (she/her/hers)

    Postdoctoral Research Fellow
    Maternal Fetal Care Center, Boston Children's Hospital
    Boston, Massachusetts, United States

    • Coauthor(s)

  • William A. Grobman, MBA, MD

    Professor
    The Ohio State University
    Columbus, Ohio, United States

  • KM

    Kelly Mosesso, MS

    Department of Biostatistics and Health Data Science, Indiana University School of Medicine
    Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indiana, United States

  • JD

    Joanne Daggy, MS, PhD

    Department of Biostatistics and Health Data Science, Indiana University School of Medicine
    Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indiana, United States

  • Ali Javinani, MD (he/him/his)

    Postdoctoral Research Fellow
    Boston Children's Hospital, Harvard Medical School
    Boston, Massachusetts, United States

  • Asma Khalil, MD

    Professor of Maternal Fetal Medicine
    Fetal Medicine Unit, St George's Hospital, St George's University of London
    London, England, United Kingdom

  • Vincenzo Berghella, MD (he/him/his)

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

  • Mark B. Landon, MD

    Richard L. Meiling Professor and Chair, Obstetrics and Gynecology
    The Ohio State University
    Columbus, Ohio, United States

  • Alireza A. Shamshirsaz, MD (he/him/his)

    Department Director, Professor of Surgery
    Fetal Surgeon Chief, Division of Fetal Medicine and Surgery Director of the Maternal Fetal Care Center Director of the Perinatal Surgery Fellowship Professor of Surgery, Boston Children’s Hospital Harvard Medical School
    Boston, Massachusetts, United States

  • Hiba J. Mustafa, MD (she/her/hers)

    Director of Fetal Surgery, Director of Placenta Accreta Spectrum Program
    Indiana University and Riley Children's Hospital
    Indianapolis, IN, United States

Objective: To investigate short-term maternal and neonatal outcomes in individuals with twin pregnancies and two prior CDs undergoing TOLAC.

Study Design: A cross-sectional study of live birth data was conducted between 2014-2021 in the United States. Individuals with twins and two prior CDs undergoing TOLAC were included. Comparison groups included those with: (1) twins and two prior CDs undergoing elective CD, (2) twins and one prior CD undergoing TOLAC, and (3) singletons and two prior CDs undergoing TOLAC. The primary outcomes were composite measures of maternal and neonatal morbidity. Maternal outcomes included chorioamnionitis, transfusion, hysterectomy, uterine rupture, ICU admission, and vaginal birth after cesarean (VBAC). Neonatal outcomes included 5-min Apgar ≤ 3, assisted ventilation, NICU admission, surfactant or antibiotic use, and seizures.Univariable and multivariable analyses were conducted with P value < 0.05 considered significant after Bonferroni adjustment.

Results: A total of 92,665 pregnant individuals and 106,361 neonates were isolated. VBAC was achieved in 37.8% (239/632) of individuals with twins and two prior CDs attempting TOLAC compared to 61.5% (2,271/3,693) in twins and one prior CD and 58% (45,834/78,969) in singletons and two prior CDs undergoing TOLAC (P< 0.001). Both composite maternal and neonatal morbidity were not significantly different between individuals with twin pregnancies and two prior CDs attempting TOLAC and other twin groups. None of the 632 individuals with twins and two prior CDs attempting TOLAC had a uterine rupture. Following adjustments with covariates, the odds of VBAC were more than twice as great in those with twins with one prior CD (aOR: 2.41; 95% CI: 2.01-2.90) and those with singletons with two prior CDs (aOR: 2.23; 95% CI: 1.88-2.65) compared to individuals with twins and two prior CDs.

Conclusion: In twin pregnancies with two prior CDs, although the chance of VBAC was 37.8%, there was no significant difference in adverse maternal or neonatal outcomes.