title: Prediction of the risk of cesarean delivery after labor induction in twin gestations based on clinical and ultrasound parameters.
abstract: OBJECTIVE
  To develop a model based on clinical and ultrasound parameters to predict the risk of cesarean delivery after labor induction in near-term twin gestations.
  
  
  METHODS
  This retrospective cohort study included 189 consecutive women with twin gestations at ≥ 36.0 weeks scheduled for labor induction. The Bishop score and transvaginal ultrasonographic measurements of cervical length were obtained immediately before labor induction. Parameters studied included maternal age, height, weight, parity, gestational age, Bishop score, cervical length, epidural analgesia, method of conception, chorionicity and birth weight. Prostaglandin E2 (dinoprostone) and oxytocin were used for labor induction. Logistic regression analysis and receiver operating characteristic curve were used to generate a predictive model for cesarean delivery.
  
  
  RESULTS
  Fifty (26.5%) of the 189 women had cesarean deliveries. According to logistic regression analysis, maternal height (P = 0.004), parity (P = 0.005) and cervical length (P = 0.016), but not Bishop score (P = 0.920), were identified as independent predictors of cesarean delivery. A risk score based on a model of these three parameters was calculated for each patient. The model was shown to have an adequate goodness of fit (P = 0.201) and the area under the curve was 0.722, indicating fairly good discrimination.
  
  
  CONCLUSIONS
  Maternal height, parity and cervical length were independent parameters for predicting the risk of cesarean delivery after labor induction in twin gestations. A predictive model using these parameters may provide useful information for deciding whether or not to induce labor.
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Bo Ryoung
authors.initials: BR
authors.lastname: Han
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. pkh0419@snubh.org.
authors.forename: Kyo Hoon
authors.initials: KH
authors.lastname: Park
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Sung Youn
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Jung
authors.affiliation: Department of Obstetrics and Gynecology, Inje University College of Medicine, Ilsan-Paik Hospital, Gyeonggi, Korea.
authors.forename: Jeong Woo
authors.initials: JW
authors.lastname: Park
mesh_terms: D000328:Adult; D001827:Body Height; D054791:Cervical Length Measurement; D002584:Cervix Uteri / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007751:Labor, Induced / Q000009:adverse effects / Q000706:statistics & numerical data*; D010298:Parity; D011247:Pregnancy; D059285:Pregnancy, Twin; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D016216:Ultrasonography, Prenatal
keywords: cervical length; cesarean delivery; labor induction; parity; twins