Time advantage of HemoCue versus traditional complete blood count during cordocentesis: 171

Abstract

STUDY DESIGN: This is a secondary analysis of a randomized controlled trial, the Twin Birth Study (TBS). In TBS, women with diamniotic twins with a cephalic presenting twin between 32 0/7 and 38 6/7 weeks gestation were randomized to planned vaginal or cesarean delivery. In this secondary analysis, women attempting vaginal birth of twins were analyzed. We performed a retrospective case-control study, according to success (vaginal delivery of both twins) or failure (cesarean of one or both twins) of twin vaginal delivery. Maternal and fetal characteristics prior to labor were evaluated in order to identify variables significantly associated with success or failure of twin vaginal birth. Logistic regression was used to create a prediction model that was validated against a training set. RESULTS: 1124 patients attempting a trial of vaginal delivery of twins were analyzed. 783 (70%) successfully delivered vaginally, and 341 (30%)had a cesarean of one or both twins. Pre-labor characteristics significantly associated with delivery route were: maternal age, parity, history of prior cesarean delivery, and presentation of the second twin. Using these characteristics, a predictive model was developed. An ROC curve was developed to assess accuracy with an AUC of 0.6 (Figure 1). CONCLUSION: We report development of a preliminary predictive model for twin vaginal birth. Characteristics that most heavily influence success of vaginal delivery are maternal age, parity, surgical history and presentation of the second twin.