Main findings
In this study, the results indicated that TOL is not associated with a higher risk of adverse perinatal outcomes or NDI at 2 years in uncomplicated MCDA twins when compared to a PCS. In the PCS group, the composite perinatal morbidity was higher (aOR 1.36, 95% CI 0.24-7.81), also finding a slightly higher rate of NDI at 2 years (10.2% vs. 4.9%) and severe NDI (3.4% vs. 0%). Attempted vaginal delivery is therefore shown to be a safe strategy with a high vaginal delivery rate.
Additionally, regarding the onset of labor in TOL group, induction of labor has been shown to be a safe strategy when performed above 35. In our study, we found a higher perinatal morbidity in the spontaneous trial of labor subgroup, with a higher rate of 2-year-NDI. Nevertheless, the composite perinatal morbidity in both subgroups was lower than that found after PCS. The vaginal delivery rate in the TOL group was higher in the spontaneous onset of labor subgroup.
The main clinical implication of this study is to provide evidence and support to parents and practitioners when deciding the mode of delivery and onset of labor in uncomplicated MCDA twins after 32 weeks of gestation.