Inducción del parto en gestaciones gemelares: estudio comparativo de oxitocina vs dinoprostona

Introduction

In the last few years the number of twin gestations that reach term has increased. Although vaginal delivery route has proven to be a safe alternative to caesarean section when first foetus is in cephalic presentation, available evidence on induction methods applied to this type of pregnancies is limited.

Methods

Retrospective observational study conducted in a tertiary hospital. Forty-four pregnant twins, with gestational age greater than 34 weeks, and with the first twin in cephalic presentation, who underwent induction of labour, were included. Vaginal prostaglandins (dinoprostone) were used in 17 cases and intravenous oxytocin in 27 cases, indication was randomised according to daily clinical practice. Results of both groups were compared in terms of safety and efficacy.

Results

No significant differences were found in the rate of caesarean section due to induction failure between oxytocin and prostaglandins (42.9% vs. 57.1%; P = .3). No differences were found either in terms of neonatal or maternal complications. Two pregnant women presented obstetric haemorrhage, the only maternal complication described, both in oxytocin group. Higher risk of caesarean section was found in women with BMI > 30 kg/m² (P = .001) and pre-induction Bishop's index ≤ 6 (RR: 2.06) (P = .005).

Conclusions

Both vaginal prostaglandins and intravenous oxytocin are similar in efficacy, maternal and neonatal safety when used in twin gestations. Bishop's index ≤ 6 and BMI > 30 are associated with higher probability of induction failure.