Trends in the use for labor analgesia in twin pregnancies: A nationwide register-based analysis in Finland

OBJECTIVES: The aim of this study is to calculate the trends in the use of labor analgesia in vaginal twin pregnancies at or after 37(+0) weeks of gestation and evaluate the use of different labor analgesia in vaginal twin deliveries when compared to vaginal singleton pregnancies. STUDY DESIGN: Data from the National Medical Birth Register during the years 2004–2018 was used to evaluate the usage of labor analgesia in vaginal twin deliveries at or after 37(+0) weeks of gestation when compared to a comparison group consisting of singleton deliveries at or after 37(+0) weeks of gestation. These results are presented as adjusted risk ratios (aORs) with 95% confidence intervals (Cis). The model was adjusted by maternal age and gestational diabetes, year of the pregnancy, and labor induction. RESULTS: A total of 3060 twin deliveries and 669 718 singleton deliveries (comparison group) were included in our study. The use of spinal analgesia in vaginal twin deliveries has shown a steadily growing trend increasing from 7.8% (95% Ci 4.8, 12.0) in 2004–24.8% (95% Ci 16.0, 33.0) in 2018. When compared to singleton deliveries, there was increased use of epidural analgesia (57.3% vs 46.1%, aOR 1.41; 95% Ci 1.31, 1.51), but lower use of spinal analgesia (12.3% vs 16.7%, aOR 0.66; 95% Ci 0.59, 0.73), another medical (7.9% vs 12.5%, aOR 0.55; 95% Ci 0.48, 0.63), and nonmedical analgesia (21.8% vs 30.2%, aOR 0.69, 95% Ci 0.63, 0.76) observed among women with twin pregnancies. CONCLUSIONS: The main finding of this study was that women with twin pregnancies had a higher rate of epidural analgesia than women with singleton pregnancies. The results of this study should be acknowledged by midwives, obstetricians, and anesthesiologists to provide optimal pain relief for mothers with twin pregnancies and encourage researchers to further research on this topic.