• M Vaajala, M Kekki, V M Mattila, and I Kuitunen.
• Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland. Electronic address: matias.vaajala@tuni.fi.
• Int J Obstet Anesth. 2023 Nov 1; 56: 103924103924.

BackgroundThe aim of this study was to assess the association between epidural labor analgesia and the mode of delivery for the second twin and to analyze the health outcomes of the second twin.MethodsIn this nationwide, retrospective, register-based cohort study, data from the National Medical Birth Register (MBR) of Finland (2004-2018) were used to analyze the association between epidural analgesia and delivery mode (emergency and urgent cesarean section, and assisted vaginal delivery) and fetal outcomes (neonatal mortality and need for intensive care unit admission) for the second twin. Multivariable logistic regression was used to assess the delivery mode and fetal outcomes of the second twin.ResultsA total of 3242 twin pregnancies with epidural analgesia were compared with a control group consisting of 2780 twin pregnancies without epidural analgesia. Epidural analgesia was associated with lower odds for all cesarean delivery (aOR 0.64, 95% CI 0.44 to 0.92) for the second twin and for emergency cesarean delivery (aOR 0.52, 95% CI 0.33 to 0.79) when compared with the odds for the second twin in the control group. Epidural analgesia was associated with lower odds of neonatal mortality for the second twin (aOR 0.61, 95% CI 0.73 to 0.90).ConclusionThis study found epidural labor analgesia was associated with a lower rate of emergency cesarean delivery and neonatal mortality for the second twin. These results should be acknowledged by obstetricians and anesthesiologists when planning optimal peripartum management for mothers with twin pregnancies.Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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