Is perinatal outcome of planned vaginal birth in multiple pregnancy influenced by using epidural analgesia: a systematic review

PURPOSE: Epidural analgesia (EA) is considered safe and advantageous in twin deliveries, yet specific evidence to support this practice is scarce. This systematic review aims to identify the impact of EA on perinatal outcomes during planned vaginal twin deliveries. METHODS: A literature search was conducted to identify studies involving vaginal multiple delivery with EA. Newcastle-Ottawa scale quality assessments were performed, and baseline characteristics and perinatal outcomes were extracted. RESULTS: Seven retrospective cohort studies were included. Quality scores ranged from 5 to 8/8 stars. Baseline characteristics and reported outcome measures were heterogenous. When comparing EA to non-EA users, incidence of CS after vaginal trial of labor was similar in one study (13% vs 21%, OR 1.65 0.70-3.90), but lower in another study (7% vs 15%, OR 0.0435 0.022-0.083). A third study reported a beneficial effect of EA for the second twin only. Anesthesiologic strategies for emergency CS were not reported. Instrumental delivery was increased or similar for women in the EA group. Apgar scores for deliveries using EA were not reduced. Perinatal mortality for the second twin was similar. CONCLUSION: EA in planned vaginal twin delivery seems to be associated with a reduced incidence of CS, a higher risk of assisted delivery, and an increased second-stage length. However, evidence of the associated consequences for mothers and neonates is limited. Given the limited number of eligible studies and reported outcomes, further research is needed to definitively assess the current practice of routine epidural administration for multiple deliveries, and to correctly inform women of its risks/benefits.