{
    "abstract": "To investigate short-term maternal and neonatal outcomes in individuals with twin pregnancies and two prior cesarean deliveries who underwent trial of labor after cesarean (TOLAC).\nA cross-sectional study of live-birth data was conducted between 2014 and 2021 in the United States. Individuals with more than two prior cesarean deliveries and multiple gestations higher than twins were excluded. The inclusion criteria were individuals with twin pregnancies who had two prior cesarean deliveries and underwent TOLAC. Comparison groups included 1) individuals with twin pregnancies and two prior cesarean deliveries who underwent elective cesarean delivery, 2) those with twin pregnancies and one prior cesarean delivery who underwent TOLAC, and 3) those with singleton pregnancies and two prior cesarean deliveries who underwent TOLAC. The primary outcomes were composite measures of maternal and neonatal morbidity. Investigated maternal outcomes included chorioamnionitis, transfusion, hysterectomy, uterine rupture, and admission to the intensive care unit. Vaginal birth after cesarean (VBAC) was also evaluated. Neonatal outcomes included a 5-minute Apgar score 3 or higher, assisted ventilation, admission to the neonatal intensive care unit, use of surfactant or antibiotics, and seizures. Univariable and multivariable analyses were conducted. Bonferroni adjustment was applied, and adjusted P <0.05 was considered significant.\nA total of 92,665 pregnant individuals and 106,361 neonates were included in the analysis. Vaginal birth after cesarean was achieved in 37.8% (239/632) of individuals with twin pregnancies and two prior cesarean deliveries who underwent TOLAC, compared with 61.5% (2,271/3,693) of individuals with twin pregnancies and one prior cesarean delivery who underwent TOLAC and 58.0% (45,834/78,969) of individuals with singleton pregnancies and two prior cesarean deliveries who underwent TOLAC ( P <.001). Both composite maternal and neonatal morbidity were not significantly different between other twin groups and individuals with twin pregnancies and two prior cesarean deliveries who underwent TOLAC. None of the 632 individuals with twin pregnancies and two prior cesarean deliveries who underwent TOLAC had uterine rupture. After adjustments with covariates, the odds of VBAC were more than twice as great in individuals with twin pregnancies and one prior cesarean delivery (adjusted odds ratio [aOR] 2.41; 95% CI, 2.01-2.90) and in those with singleton pregnancies and two prior cesarean deliveries (aOR 2.23; 95% CI, 1.88-2.65) compared with individuals with twin pregnancies and two prior cesarean deliveries.\nNo significant difference in adverse maternal or neonatal outcomes were detected in twin pregnancies among individuals with two prior cesarean deliveries, although the chance of VBAC was 37.8%.",
    "authors": [
        {
            "affiliation": "Riley Children's, the Division of Maternal-Fetal Medicine, Indiana University Health Fetal Center, and the Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana; the Division of Maternal-Fetal Medicine and Surgery, Fetal Care and Surgery Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; the Department of Obstetrics and Gynecology, Brown University Medical School, Providence, Rhode Island; the Fetal Medicine Unit, St George's Hospital, St George's University of London, London, United Kingdom; the Division of Maternal-Fetal Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania; and the Division of Maternal-Fetal Medicine, The Ohio State University, Columbus, Ohio.",
            "firstname": "Hiba J",
            "initials": "HJ",
            "lastname": "Mustafa"
        },
        {
            "affiliation": null,
            "firstname": "May",
            "initials": "M",
            "lastname": "Abiad"
        },
        {
            "affiliation": null,
            "firstname": "William A",
            "initials": "WA",
            "lastname": "Grobman"
        },
        {
            "affiliation": null,
            "firstname": "Kelly M",
            "initials": "KM",
            "lastname": "Mosesso"
        },
        {
            "affiliation": null,
            "firstname": "Joanne K",
            "initials": "JK",
            "lastname": "Daggy"
        },
        {
            "affiliation": null,
            "firstname": "Ali",
            "initials": "A",
            "lastname": "Javinani"
        },
        {
            "affiliation": null,
            "firstname": "Asma",
            "initials": "A",
            "lastname": "Khalil"
        },
        {
            "affiliation": null,
            "firstname": "Vincenzo",
            "initials": "V",
            "lastname": "Berghella"
        },
        {
            "affiliation": null,
            "firstname": "Mark B",
            "initials": "MB",
            "lastname": "Landon"
        },
        {
            "affiliation": null,
            "firstname": "Alireza A",
            "initials": "AA",
            "lastname": "Shamshirsaz"
        }
    ],
    "conclusions": "No significant difference in adverse maternal or neonatal outcomes were detected in twin pregnancies among individuals with two prior cesarean deliveries, although the chance of VBAC was 37.8%.",
    "copyrights": "Copyright \u00a9 2025 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.",
    "doi": "10.1097/AOG.0000000000005830\n10.1016/j.ajog.2005.05.066\n10.1056/NEJMoa040405\n10.1016/j.ajog.2023.02.008\n10.1016/j.ajog.2018.11.125\n10.1111/birt.12434\n10.1016/j.ajog.2005.03.023\n10.1002/ijgo.14090\n10.1016/j.ajog.2017.10.154\n10.3109/14767050903156700\n10.1111/jog.14154\n10.1016/j.ajog.2007.03.013\n10.3390/jcm11154256\n10.1007/s00404-021-06368-1\n10.1016/j.ajog.2021.05.021\n10.1097/AOG.0000000000003078\n10.1016/j.fertnstert.2021.03.032\n10.1007/s00404-021-06062-2\n10.1053/j.semperi.2016.03.003\n10.1097/01.AOG.0000259312.36053.02\n10.1016/j.ajogmf.2022.10064",
    "journal": "Obstetrics and gynecology",
    "keywords": [],
    "methods": null,
    "publication_date": "2025-01-17",
    "pubmed_id": "39820347",
    "results": "A total of 92,665 pregnant individuals and 106,361 neonates were included in the analysis. Vaginal birth after cesarean was achieved in 37.8% (239/632) of individuals with twin pregnancies and two prior cesarean deliveries who underwent TOLAC, compared with 61.5% (2,271/3,693) of individuals with twin pregnancies and one prior cesarean delivery who underwent TOLAC and 58.0% (45,834/78,969) of individuals with singleton pregnancies and two prior cesarean deliveries who underwent TOLAC ( P <.001). Both composite maternal and neonatal morbidity were not significantly different between other twin groups and individuals with twin pregnancies and two prior cesarean deliveries who underwent TOLAC. None of the 632 individuals with twin pregnancies and two prior cesarean deliveries who underwent TOLAC had uterine rupture. After adjustments with covariates, the odds of VBAC were more than twice as great in individuals with twin pregnancies and one prior cesarean delivery (adjusted odds ratio [aOR] 2.41; 95% CI, 2.01-2.90) and in those with singleton pregnancies and two prior cesarean deliveries (aOR 2.23; 95% CI, 1.88-2.65) compared with individuals with twin pregnancies and two prior cesarean deliveries.",
    "title": "Trial of Labor After Cesarean Delivery in Individuals With Twin Pregnancies and Two Prior Cesarean Deliveries.",
    "xml": "<Element 'PubmedArticle' at 0x788506f61e40>"
}