The impact of prolonged second stage in twins on perinatal outcomes

Abstract

Objective: To assess the duration of the second stage of labor in twin pregnancies in relation to maternal and neonatal outcomes.

Methods: A retrospective study between 2014 and 2020. Eligible cases were twin pregnancies that reached the second stage. The pre-defined groups were based on the total time spent in the second stage of labor; Group 1 (<1 h), group 2 (1-2 h), and group 3 (>2 h), which was considered the prolonged second stage group.

Results: Among the 439 planned vaginal births, successful vaginal delivery of both twins was achieved in 63.8%. Prolonged second stage was observed in 25.8% (89/345). Nulliparity (odds ratio [OR] 7.72, 95% confidence interval [CI] 4.5-13.4) and use of epidural analgesia (OR 5.45, 95% CI 1.2-24.7), were the only independent variables significantly associated with prolonged second stage. Prolonged second stage was associated with a greater risk of intrapartum cesarean delivery (32.6%, P < 0.001), combined delivery (10.1%, P < 0.001), chorioamnionitis (8.3%, P = 0.006) and a admission to neonatal intensive care unit of at least one of the twins (30.3%, P = 0.02).

Conclusion: Prolonged second stage of labor affects maternal and fetal outcome in twin pregnancies.

Keywords: outcome; pregnancy; second stage of labor; twins; vaginal delivery.