Clinical trial of induction of labor versus expectant management in twin pregnancy.
The appropriate date of delivery in twin pregnancies is supposed to be earlier than that in singleton pregnancy. The aim of this study was to compare two strategies for managing twin pregnancies (i.e., immediate induction and expectant management).
                Seventeen patients underwent immediately induced labor by administration of oral prostaglandin E(2) at 37 weeks, while 19 patients underwent expectant management.
                The average gestational age at delivery in the induction group was 37.5 +/- 0.4 weeks, significantly earlier than that in the expectant management group (39.0 +/- 1.1 weeks). However, there were no significant differences in the average birth weight between the two groups (2, 700 +/- 330 g in the induction group vs. 2,672 +/- 392 g in the expectant management group). The cesarean delivery rate in the induction group was 18%, not significantly different from that in the expectant management group (32%). The most common indication for cesarean section in the expectant management group was maternal infection, while there was no maternal infection in the induction group (p = 0.08).
                It may be acceptable do intervene in twin pregnancies earlier than in singleton pregnancies during term.
                Copyright 2000 S. Karger AG, Basel
The small trial identified was underpowered to detect the outcome measures of interest. Consequently, there are insufficient data available to support a practice of elective delivery from 37 weeks' gestation for women with an otherwise uncomplicated twin pregnancy at term.