April 8th, 2020

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Is the Protocol for Induction of Labor in Singletons Applicable to Twin Gestations?
Authors:  Michael D. Wolfe, M.D., Lesley de la Torre, M.D., Lisa E. Moore, M.D., Orrin Myers, Ph.D., and William F. Rayburn, M.D., M.B.A.
  OBJECTIVE: To evaluate the success of induction of labor in twin gestations using standard protocols for misoprostol and oxytocin designed for singleton gestations.

STUDY DESIGN: This retrospective cohort study involved all diamniotic twin gestations that were induced at ≥32 weeks’ gestation with intact membranes. Two singleton pregnancies were matched for each twin pregnancy. Use of intravaginal misoprostol and low-dose intravenous oxytocin was based on ACOG management guidelines.

RESULTS: A small proportion (40 of 430 [9.3%]) of twins met the inclusion criteria for an induction of labor. Misoprostol was utilized less frequently with twins than with singletons (55% vs. 78%, p=0.02) because of the higher preinduction Bishop score. Doses of oxytocin were comparable between the 2 groups. A high rate of vaginal delivery was seen in the twin and singleton groups (85.0% vs. 80.0%, p=0.62) with similar neonatal outcomes.

CONCLUSION: A standard protocol of labor induction for singleton gestations would apply for twins with overall favorable intrapartum outcomes.
Keywords:  induced labor, misoprostol, twins
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