International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026
Early versus late amniotomy during twin labor.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Eliner Or, Lidor Inbar, Touval Or, Shechter Maor Gil, Kovo Michal, Biron-Shental Tal
Аннотация
OBJECTIVE: This study evaluates whether timing of amniotomy affects labor characteristics and maternal and neonatal outcomes in twin deliveries.
METHODS: This retrospective study was conducted at a single academic medical center and included dichorionic diamniotic (DCDA) twin pregnancies with a normal anomaly scan and a vertex-presenting leading twin, delivered over a 7-year period. The cohort was divided into two groups: early amniotomy (performed at cervical dilation ≤3 cm) and late amniotomy (performed at >3 cm cervical dilation). Exclusion criteria included monochorionic twin pregnancies and planned elective cesarean deliveries. Maternal demographics, delivery characteristics, and neonatal outcomes were compared between groups.
RESULTS: Of 51 592 deliveries, 1196 were twins; 565 DCDA pregnancies met the inclusion criteria (early n = 279; late n = 286). Groups were similar in age, body mass index (kg/m2), comorbidities, and gestation. Nulliparity and intrapartum cesarean rates were more common in the early amniotomy group (56.6% vs. 29.4%; P < 0.001, 24.4% vs. 9.8%; P < 0.001, respectively). Induction and augmentation rates, rupture-to-delivery interval, second stage duration, intrapartum fever, and meconium were similar. Neonatal outcomes, including birthweight, 5-min Apgar <7, neonatal intensive care unit admission, and composite morbidity were comparable. On adjusted analysis, early amniotomy (adjusted odds ratio [aOR] 1.84; 95% confidence interval 1.09-3.1), nulliparity (aOR 5.60; 3.17-9.87), and previous cesarean (aOR 3.94; 1.32-11.77) increased cesarean risk, whereas epidural was protective (aOR 0.40; 0.24-0.67).
CONCLUSION: In DCDA twin labor, early amniotomy (≤3 cm) is associated with increased intrapartum cesarean, despite similar durations of labor and neonatal outcomes. Amniotomy timing should be individualized, with caution against routine early rupture.
METHODS: This retrospective study was conducted at a single academic medical center and included dichorionic diamniotic (DCDA) twin pregnancies with a normal anomaly scan and a vertex-presenting leading twin, delivered over a 7-year period. The cohort was divided into two groups: early amniotomy (performed at cervical dilation ≤3 cm) and late amniotomy (performed at >3 cm cervical dilation). Exclusion criteria included monochorionic twin pregnancies and planned elective cesarean deliveries. Maternal demographics, delivery characteristics, and neonatal outcomes were compared between groups.
RESULTS: Of 51 592 deliveries, 1196 were twins; 565 DCDA pregnancies met the inclusion criteria (early n = 279; late n = 286). Groups were similar in age, body mass index (kg/m2), comorbidities, and gestation. Nulliparity and intrapartum cesarean rates were more common in the early amniotomy group (56.6% vs. 29.4%; P < 0.001, 24.4% vs. 9.8%; P < 0.001, respectively). Induction and augmentation rates, rupture-to-delivery interval, second stage duration, intrapartum fever, and meconium were similar. Neonatal outcomes, including birthweight, 5-min Apgar <7, neonatal intensive care unit admission, and composite morbidity were comparable. On adjusted analysis, early amniotomy (adjusted odds ratio [aOR] 1.84; 95% confidence interval 1.09-3.1), nulliparity (aOR 5.60; 3.17-9.87), and previous cesarean (aOR 3.94; 1.32-11.77) increased cesarean risk, whereas epidural was protective (aOR 0.40; 0.24-0.67).
CONCLUSION: In DCDA twin labor, early amniotomy (≤3 cm) is associated with increased intrapartum cesarean, despite similar durations of labor and neonatal outcomes. Amniotomy timing should be individualized, with caution against routine early rupture.