RISK-FACTORS FOR CESAREAN DELIVERY IN TWIN GESTATIONS NEAR-TERM

Objective: We evaluated the risk factors associated with cesarean deli very in laboring twin gestations at least 36 completed weeks. Methods: We reviewed the records of 134 women with twin gestations who underwe nt a trial of labor between 1993 and 1995. Women who delivered by cesa rean were compared with women who delivered vaginally. The factors ass ociated with an increased risk for cesarean were determined using univ ariate analysis. Logistic regression was used to determine which of th ose factors was most strongly associated with cesarean delivery. Resul ts: Of 134 laboring twin gestations, 25 (18.7%) delivered by cesarean and 109 (81.3%) delivered vaginally. Univariate analysis revealed that women who delivered by cesarean were more likely to be nulliparous, h ave a less advanced cervix at both admission and epidural placement, a higher mean oxytocin infusion rate for induction or augmentation of l abor, a combined fetal weight greater than 5500 g, and received magnes ium for seizure prophylaxis. Multivariate analysis identified that nul liparity and timing of epidural administration were the factors most s trongly associated with cesarean delivery. Conclusion: The timing of e pidural analgesia is a modifiable risk factor strongly associated with cesarean delivery in term and near-term laboring twin gestations. (Ob stet Gynecol 1998;92:940-4. (C) 1998 by The American College of Obstet ricians and Gynecologists.).