Obstetrical Profile of Twin Pregnancies: A Retrospective Review of 11 Years (1969–1979) at Hôpital Notre-Dame, Montréal, Canada

Four hundred and thirty-four twins delivered from 220 women at Notre-Dame Hospital were studied during a period of 11 years (1969–1979). The maternal, fetal, and neonatal outcome was compared before and after 1974, the year ultrasonography and other changes in perinatal care were introduced in our institution. Early diagnosis occurred more frequently after 1974, together with increased antenatal hospitalization. Preeclampsia and hepatic cholestasis occurred in 19.5% and 9.5% of women, respectively. Preterm delivery occurred in 42.2% of the cases. The corrected fetal mortality rate was 30.2/1,000 and corrected perinatal mortality rate was 74.9/1,000. About 90% of the neonatal deaths occurred in infants born before 36 weeks. Internal version and complete extraction of the second twin increased the neonatal mortality sixfold compared to spontaneous delivery. Availability of ultrasound examination significantly reduced preterm delivery.

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Perinatal Profile of Twin Pregnancies: A Retrospective Review of 11 Years (1969–1979) at Hôpital Notre-Dame, Montréal, Canada

Acta geneticae medicae et gemellologiae twin research ◽

10.1017/s0001566000008242 ◽

1982 ◽

Vol 31 (3-4) ◽

pp. 157-163 ◽

Cited By ~ 6

Author(s):

Marie-Françoise Desgranges ◽

Xavier De Muylder ◽

Jean-Marie Moutquin ◽

Francisco Lazaro-Lopez ◽

Bernard Leduc

Keyword(s):

Perinatal Mortality ◽

Perinatal Care ◽

Fetal Mortality ◽

Ultrasound Technique ◽

Intrauterine Growth ◽

Before And After ◽

The Impact ◽

Second Period ◽

Twin Pregnancies ◽

Main Factor

Four hundred and thirty four twins occurring in 220 women were studied during a period of 11 years (1969–1979) at Notre-Dame Hospital.Perinatal mortality (< 28 days) was compared before and after 1974, and the impact of ultrasound technique upon perinatal outcome was assessed during the second period (1974–1979). The main factor associated with perinatal mortality was low birth weight caused by either prematurity or intrauterine growth retardation.While fetal mortality remained unchanged within the two study periods, neonatal mortality decreased from 68.2/1,000 to 28.9/1,000 mainly due to increased survival rate of twins below 1,500 g at birth.With identical perinatal care during the same period, perinatal mortality and incidence of intrauterine growth-retarded twins remained unchanged despite early diagnosis by ultrasound.

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Prediction of Spontaneous Preterm Delivery in Twin Pregnancies By Cervical Length at Mid-Gestation

Twin Research and Human Genetics ◽

10.1375/twin.11.5.552 ◽

2008 ◽

Vol 11 (5) ◽

pp. 552-557 ◽

Cited By ~ 20

Author(s):

Katharina Klein ◽

Hubertus Gregor ◽

Kora Hirtenlehner-Ferber ◽

Maria Stammler-Safar ◽

Armin Witt ◽

...

Keyword(s):

Preterm Delivery ◽

Smoking Habit ◽

Cervical Length ◽

Spontaneous Preterm Delivery ◽

Spontaneous Labour ◽

High Incidence ◽

High Cervical ◽

Twin Pregnancies ◽

Preterm Rupture Of Membranes ◽

Spontaneous Delivery

AbstractThe objective of our study was to evaluate the correlation of the cervical length at 20–25 weeks of gestation with the incidence of spontaneous preterm delivery in twins in a country with a high incidence of preterm delivery compared to other European countries. Cervical length was measured in 262 consecutive patients. Previous preterm delivery before 34 weeks of gestation, chorionicity, maternal age, body-mass-index, smoking habit and parity were recorded as risk factors for preterm delivery. Women who were symptomatic at 20–25 weeks and who delivered because of other reasons than spontaneous labour and preterm rupture of membranes or at term were excluded. The primary outcome was incidence of preterm birth before 34 weeks. Two hundred and twenty-three patients were analyzed. Thirty-two (14%) delivered before 34 weeks. There was a significant correlation between cervical length of less than 25 mm and spontaneous delivery before 34 weeks (50% vs. 13%,p= .007). In addition, logistic regression analysis found cervical length to be the only significant predictor of spontaneous delivery before 34 weeks (OR 1.084; 95% CI 1.015; 1.159;p= .017). We conclude that the risk of severe preterm delivery in twins is high. Cervical length at mid-gestation was the only predictor of delivery before 34 weeks.

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Successfully delayed delivery of second twin after early second trimester rupture of membranes of the first twin: a case report

Archives of Public Health ◽

10.3889/aph.2020.5193 ◽

2020 ◽

Vol 12 (2) ◽

pp. 81-85

Author(s):

Jadranka Georgievska ◽

Igor Samardziski ◽

Ana Daneva ◽

Goran Kocoski

Keyword(s):

Preterm Delivery ◽

Good Condition ◽

Fetal Lung ◽

Intrauterine Death ◽

Lung Maturation ◽

Uterine Contractions ◽

Regular Control ◽

Level Institution ◽

Twin Pregnancies ◽

Second Twin

Twin pregnancies are high-risk pregnancies accompanied with multiple complications, such as: spontaneous abortion, preterm rupture of the membranes, preterm delivery, intrauterine death of one or both twins etc. There is no consensus about the management of twin pregnancies complicated with preterm rupture of the membranes of one twin and risk of preterm delivery. These cases are rarely found in the literature. We present a case of a 35 years old patient, hospitalized in a tertiary level institution, because of a diamniotic dichorionic twin pregnancy complicated with preterm rupture of the membranes of the first twin at 19 weeks of gestation. She had one delivery with Caesarean section 16 years ago. In consultation with the patient induction of labor was done with delivery of the first twin, a death male fetus. After that, antibiotics and tocolytic therapy were administrated and the patient remained in the hospital about one week. The patient was discharged at home with regular control of her condition and condition of the fetus. The patient was again hospitalized at 33 weeks of gestation with uterine contractions on cardiotocography. After administration of corticosteroid therapy for fetal lung maturation she delivered spontaneously the second twin in a good condition and she was discharged from hospital after 16 days. In twin pregnancies clinicians must think about delayed interval delivery of the second twin, after delivery of the first twin, with an aim to increase chances for survival, especially for pregnancies less than 30 weeks of gestation.

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The Second Twin: Retained and Unretained

Tropical Doctor ◽

10.1177/004947559502500316 ◽

1995 ◽

Vol 25 (3) ◽

pp. 132-133 ◽

Cited By ~ 5

Author(s):

J I Brian Adinma ◽

Andy O Agbai

Keyword(s):

Mortality Rate ◽

Perinatal Mortality ◽

Early Recognition ◽

Remedial Measures ◽

Apgar Scores ◽

Perinatal Mortality Rate ◽

Uterine Inertia ◽

Comparative Review ◽

Twin Pregnancies ◽

Second Twin

In this comparative review of retained and unretained second twins, the commonest causes of retention of the second twins were found to be uterine inertia (48.4%) and obstruction from malpresentation and malposition (32.3%). The pair-presentation most likely to be retained was vertex/transverse. Apgar scores were lower for retained than unretained second twins. The perinatal mortality rate was significantly higher for the retained second twins (258/1000) compared to the unretained second twins (60.2/1000) ( P < 0.002). Early recognition of twin pregnancies in which the 2nd twin is more likely to be retained, and prompt application of appropriate remedial measures would reduce the incidence of retention of the second twin.

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Time Trends in Characteristics and Outcome of Twin Pregnancies

Acta geneticae medicae et gemellologiae twin research ◽

10.1017/s0001566000002622 ◽

1991 ◽

Vol 40 (2) ◽

pp. 181-192 ◽

Cited By ~ 6

Author(s):

L. Moreault ◽

S. Marcoux ◽

J. Fabia ◽

S. Tennina

Keyword(s):

Mortality Rate ◽

Neonatal Mortality ◽

Low Birthweight ◽

Preterm Births ◽

Mortality Rates ◽

Fetal Mortality ◽

Neonatal Mortality Rate ◽

Risk Of Death ◽

Twin Pregnancies ◽

Over Time

AbstractThis study describes the evolution in fetal and neonatal mortality rates among twin pairs born in 22 hospitals located in the eastern regions of the province of Quebec in 1976-1978 (n = 776 pairs) and 1982-1985 (n = 712 pairs). It also assesses the contribution of maternal factors, obstetrical care and characteristics of twins in the variation of the risk of death over time. The fetal mortality rate did not improve from 1976-1978 (22.6 per 1000) to 1982-1985 (28.1 per 1000). However, the neonatal mortality rate declined from 44.7 to 34.7 per 1000 liveborn first twins and from 56.8 to 36.1 per 1000 liveborn second twins. For first twins as for second twins, birthweight-specific neonatal mortality rates decreased within birth weight categories under 2500 g. In the second period, 96.9% of twin pregnancies were detected before confinement compared to 59.6% in the earlier period. The proportion of twins delivered by obstetricians, the percentage of twin births occurring in ultraspecialized perinatal units and the frequency of caesarean sections increased markedly. The proportion of preterm births increased over time (34.5% vs 43.1%) whereas the percentage of low birthweight twins decreased but not significantly (54.3% 51.6%). In this study, changes in maternal age, parity, educational level, sex of pairs, qualification of the physician, and level of care available at the hospital of birth, did not account for the decrease in neonatal mortality rates among twins. The increase in the frequency of caesarean sections seemed to explain only a small proportion of the decrease in the neonatal mortality rate among second twins. In the second as well as in the first period, the neonatal mortality rate for twins was six times higher than that for singletons.

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Reduction in Perinatal Mortality after Implementation of HBB Training at a District Hospital in Mali

Journal of Tropical Pediatrics ◽

10.1093/tropej/fmz072 ◽

2019 ◽

Vol 66 (3) ◽

pp. 315-321

Author(s):

M Innerdal ◽

I Simaga ◽

H Diall ◽

M Eielsen ◽

S Niermeyer ◽

...

Keyword(s):

Mortality Rate ◽

Neonatal Mortality ◽

Perinatal Mortality ◽

District Hospital ◽

Neonatal Mortality Rate ◽

Neonatal Deaths ◽

Live Births ◽

Early Neonatal Mortality ◽

Helping Babies Breathe ◽

Before And After

Abstract Background Mali has a high neonatal mortality rate of 38/1000 live births; in addition the fresh stillbirth rate (FSR) is 23/1000 births and of these one-third are caused by intrapartum events. Objectives The aims are to evaluate the effect of helping babies breathe (HBB) on mortality rate at a district hospital in Kati district, Mali. Methods HBB first edition was implemented in April 2016. One year later the birth attendants were trained in HBB second edition and started frequent repetition training. This is a before and after study comparing the perinatal mortality during the period before HBB training with the period after HBB training, the period after HBB first edition and the period after HBB second edition. Perinatal mortality is defined as FSR plus neonatal deaths in the first 24 h of life. Results There was a significant reduction in perinatal mortality rate (PMR) between the period before and after HBB training, from 21.7/1000 births to 6.0/1000 live births; RR 0.27, (95% CI 0.19–0.41; p < 0.0001). Very early neonatal mortality rate (24 h) decreased significantly from 6.3/1000 to 0.8/1000 live births; RR 0.12 (95% CI 0.05–0.33; p = 0.0006). FSR decreased from 15.7/1000 to 5.3/1000, RR 0.33 (95% CI 0.22–0.52; p < 0.0001). No further reduction occurred after introducing the HBB second edition. Conclusion HBB may be effective in a local first-level referral hospital in Mali.

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Management of Twin Labor

Acta geneticae medicae et gemellologiae ◽

10.1017/s1120962300024380 ◽

1972 ◽

Vol 22 (S1) ◽

pp. 70-72

Author(s):

Z. Sternadel ◽

A. Lysikiewicz

Keyword(s):

Maternal Mortality ◽

Perinatal Mortality ◽

Apgar Score ◽

Optimum Time ◽

Neonatal Deaths ◽

Uterine Contractions ◽

The Mean ◽

Twin Pregnancies ◽

Second Twin ◽

Stimulation Of

Investigations were carried out on 68 labors in twin pregnancies. It was observed that, upon stimulation of uterine contractions by means of oxytocic agents, mainly oxytocin (90%), the mean duration of labor was significantly reduced to about 7 hours, and prolonged labors (over 20 hours) were completely eliminated. The time between delivery of the first and the second baby is now below 30 minutes in all cases, and this is regarded as the optimum time. No neonatal deaths were observed in labors taking place at term. The condition of the newborns at birth was estimated in accordance with the Apgar score and it was found that the second newborn scored worse than the first one; a fact definitely related to the higher proportion of operative procedures during delivery of the second twin (48%) as compared to the first one (10%).The authors stress that, owing to the introduction of the method of conducting twin labors, maternal mortality has been completely eliminated and twin perinatal mortality has been markedly reduced: from about 28% in 1923-1962 to about 10% in recent years.

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Management of Some Aspects of Twin Labor and Delivery

Acta geneticae medicae et gemellologiae ◽

10.1017/s1120962300024379 ◽

1972 ◽

Vol 22 (S1) ◽

pp. 62-69 ◽

Cited By ~ 1

Author(s):

F. Leroy

Keyword(s):

Mortality Rate ◽

Twin Pregnancy ◽

Fetal Mortality ◽

Time Interval ◽

Labor And Delivery ◽

Twin Birth ◽

Rate Versus ◽

Obstetrical Management ◽

Second Twin

Our data show that oxytocic perfusion should be liberally given during twin pregnancy labor, since its use is correlated with lower fetal mortality, especially of the second premature twin. This therapy might act, namely, by reducing the number of second-twin abnormal presentations. In our series, the higher mortality rate associated with lengthening of time interval between both births could be attributed to second-twin abnormal presentations. However, mortality rate versus time interval in spontaneous twin deliveries warrants obstetrical management providing second-twin birth within 15 minutes.

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