Induction of labor
The clinical decision regarding IOL was made at the discretion of the attending physician. Induction was performed either by transvaginal prostaglandin (dinoprostone or misoprostol), intravenous oxytocin infusion, or a combination of both.18,20-22 Electronic monitoring of the fetal heart rate was performed continuously. After the delivery of the first baby, use of ultrasonography was conducted to check the presentation and heart rate of the second baby. If the second baby was in the cephalic presentation, we waited for spontaneous engagement and vaginal delivery with or without the use of vacuum extraction. If the second baby had a non-reassuring fetal heart rate or was not in the cephalic presentation, the obstetrician determined the best delivery method (vacuum extraction, total breech extraction with or without internal podalic version, or combined intrapartum cesarean section). The diagnosis of failure to progress or fetal distress and the subsequent decision for cesarean delivery was made by the attending physician.