Management of Twin Labor

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.

scholarly journals Twin Deliveries: The Prevalence and Perinatal Outcomes in Public Hospitals in Dar es Salaam City, Tanzania

2020 ◽  
Author(s):  
Zavery Benela ◽  
Alfred Chibwae ◽  
Ola Jahanpour ◽  
Dismas Matovelo
Keyword(s):  
Perinatal Mortality ◽  
Vaginal Delivery ◽  
Apgar Score ◽  
Dar Es Salaam ◽  
Public Hospitals ◽  
Active Management ◽  
P Value ◽  
Major Mode ◽  
Twin Pregnancies ◽  
Second Twin

Abstract Background The perinatal mortality rates are five times higher in twin pregnancies than singleton pregnancies, therefore antenatal management and safe delivery of twin pregnancies are important issues in obstetrics. This study aimed at providing data on the proportion of twin deliveries in four public hospitals in Dar es Salaam and an insight on the fetal outcomes in relation to their modes of delivery. Methods This was a cross sectional study in which all women who delivered twin babies were interviewed and medical records on their delivery summary were obtained in the labour and post-natal wards in four public hospitals in Dar es Salaam between July and December 2011. Post-natal follow up was done on seventh day by contacting women by telephone to establish the neonatal status. Results There were 33,638 total deliveries of which 672 were twin deliveries making the prevalence of 2.0% (20 per 1,000 births). Of all twin deliveries analyzed (666 pairs), 373(56.0%) had the diagnosis of twin pregnancy made antenatally. Vaginal delivery was the major mode of delivery (77.3%). whereas combined delivery in which the first twin was delivered vaginally and the second twin by caesarian section accounted for only 2.6%. At birth 1252(94%) of twins were alive, 60(4.5%), were fresh stillbirths and 20(1.5%) were macerated stillbirths. Low Apgar score was more to first twins delivered vaginally compared to first twins (p-value=0.003). Low Apgar score (AS <7) was more amongst second twins delivered vaginally at 30 minutes or longer 27(48.2%) compared to twins delivered in less than 30 minutes 72(15.4%), (p-value=0.001). Conclusion There was a significant association between vaginal delivery and low Apgar score at one minute. Long duration of twin to twin delivery interval was associated with low Apgar score of the second twins delivered vaginally. Perinatal mortality rate was also higher in the second twins compared to the first twins. The time delivery interval of the second twin should be made as short as possible by active management of all second twins. Neonatal facilities are required in all hospitals conducting twin deliveries to care for premature babies.

scholarly journals Perinatal Outcome in Twin Pregnancy at Khaipur Medical College, Khairpur Mirs, Pakistan

2021 ◽  
pp. 46-52
Author(s):  
Nusrat Fozia Pathan ◽  
Shazia Jamali ◽  
Maqsood Ahmed Siddiqui ◽  
Khushi Muhammad Sohu ◽  
Ameer Ali Jamali ◽  
...  
Keyword(s):  
Perinatal Mortality ◽  
Gestational Age ◽  
Apgar Score ◽  
Perinatal Outcome ◽  
Twin Pregnancy ◽  
Mode Of Delivery ◽  
Case Series ◽  
Risk Pregnancy ◽  
The Mean ◽  
Twin Pregnancies

Objective: To determine the perinatal outcome of twin pregnancy and to find out the frequency of twin deliveries in hospital based population. Study Design: Descriptive case series. Place and Duration of Study: The study was conducted over a period of 02 Year 1st January 2018 to 31st December 2019 in the Obstetrics and Gynaecology Department at KMC Khairpur Mirs, Sindh Pakistan. Methodology: All the patients of age 20-35 years with twin pregnancies of gestational age above 30 weeks presenting in labour ward of KMC Khairpur Mirs were studied. A detailed history was taken, general physical (G.P) examination and obstetrical examination performed, targeted investigations carried out to detect various fetal complications. Patients were assessed for a mode of delivery, records for data like age, gestational age, weight of baby, APGAR score expressed in term of mean±SD and data like perinatal mortality, prematurity, intra uterine growth restriction (IUGR), the weight of baby and APGAR score expressed in terms of frequencies and percentages on SPSS version 20. Results: In this study total numbers of deliveries were 7200, among them 83 were twin pregnancies the frequency of twin was 1.15%. Booked cases were 24.1%, unbooked was 75.9%. The highest incidence of 42.2% of twin gestation was seen in women between ages 31-35 years, the mean age of patients was seen 30.1±4.1 and regarding the parity incidence was high 54.2% in multiparous l-5. The total number of preterm deliveries was 45(55.2%), gestational age was (35-36+6dnys) weeks in 22.89% of cases, and the mean gestational age of patients was 35.7±2.5. Perinatal mortality was 38(22.9%), stillborn and early neonatal deaths (ENND) were 18.4% and 36.8% and common in twin-2. Conclusion: Twin pregnancy is-a-high-risk-pregnancy still is a major obstetrical and perinatal challenge. The frequency of twin pregnancy seen in this study is 1.15% unbooked and unsupervised pregnancies are more common i.e 75.9%.  Prematurity is common perinatal morbidity 51.20%.  perinatal mortality is 22.9% and highest in twin-2.

scholarly journals Twin Deliveries: The Prevalence and Perinatal Outcomes in Public Hospitals in Dar es Salaam City, Tanzania

2019 ◽  
Author(s):  
Zavery Benela ◽  
Alfred Chibwae ◽  
Ola Jahanpour ◽  
Dismas Matovelo
Keyword(s):  
Perinatal Mortality ◽  
Vaginal Delivery ◽  
Apgar Score ◽  
Dar Es Salaam ◽  
Public Hospitals ◽  
Active Management ◽  
P Value ◽  
Major Mode ◽  
Twin Pregnancies ◽  
Second Twin

Abstract Background The perinatal mortality rates are five times higher in twin pregnancies than singleton pregnancies, therefore antenatal management and safe delivery of twin pregnancies are important issues in obstetrics. This study aimed at providing data on the proportion of twin deliveries in four public hospitals in Dar es Salaam and an insight on the fetal outcomes in relation to their modes of delivery.Methods This was a cross sectional study in which all women who delivered twin babies were interviewed and medical records on their delivery summary were obtained in the labour and post-natal wards in four public hospitals in Dar es Salaam between July and December 2011. Post-natal follow up was done on seventh day by contacting women by telephone to establish the neonatal status.Results There were 33,638 total deliveries of which 672 were twin deliveries making the prevalence of 2.0% (20 per 1,000 births). Of all twin deliveries analyzed (666 pairs), 373(56.0%) had the diagnosis of twin pregnancy made antenatally. Vaginal delivery was the major mode of delivery (77.3%). whereas combined delivery in which the first twin was delivered vaginally and the second twin by caesarian section accounted for only 2.6%. At birth 1252(94%) of twins were alive, 60(4.5%), were fresh stillbirths and 20(1.5%) were macerated stillbirths. Low Apgar score was more to first twins delivered vaginally compared to first twins (p-value=0.003). Low Apgar score (AS <7) was more amongst second twins delivered vaginally at 30 minutes or longer 27(48.2%) compared to twins delivered in less than 30 minutes 72(15.4%), (p-value=0.001).Conclusion There was a significant association between vaginal delivery and low Apgar score at one minute. Long duration of twin to twin delivery interval was associated with low Apgar score of the second twins delivered vaginally. Perinatal mortality rate was also higher in the second twins compared to the first twins. The time delivery interval of the second twin should be made as short as possible by active management of all second twins. Neonatal facilities are required in all hospitals conducting twin deliveries to care for premature babies.

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

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.

The Second Twin: Retained and Unretained

1995 ◽  
Vol 25 (3) ◽  
pp. 132-133 ◽  
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.

scholarly journals Twin Pregnancy in Brazil: A Profile Analysis Exploring Population Information from the National Birth E-Registry on Live Births

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Danielly S. Santana ◽  
Renato T. Souza ◽  
Fernanda G. Surita ◽  
Juliana L. Argenton ◽  
Cleide M. Silva ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Apgar Score ◽  
Twin Pregnancy ◽  
Profile Analysis ◽  
Multiple Logistic Regression Analysis ◽  
Perinatal Outcomes ◽  
Prevalence Ratio ◽  
Twin Pregnancies ◽  
Minute Apgar Score ◽  
Second Twin

Birth records as SINASC (Brazilian Live Birth Information System) are highlighted in uncommon conditions such as twin pregnancy whose prevalence rarely exceeds 2 to 3% of the total number of births. The objective of this study was to assess the prevalence of twin pregnancies in Brazil and their maternal and perinatal characteristics using data from the national birth e-Registry. All births in Brazil from 2011 to 2014 were assessed. Prevalence of twin pregnancies per region was assessed and correlated with the Human Development Index (HDI). Sociodemographic and obstetric factors and main perinatal outcomes were assessed for the first and second twin, in comparison to singletons, and the second twin compared to the first twin, with PR and 95%CI. A multiple logistic regression analysis was conducted to identify factors independently associated with a low 5-minute Apgar score in twin pregnancies. Twin pregnancy occurred in 1.13% in Brazil, with a higher prevalence in regions with a higher HDI. It was associated with a complete higher level of education (22.9% versus 16.3% for singles) and maternal age > 35 years (17.5% versus 11.4% for singles). Preterm birth <32 weeks (prevalence ratio-PR 12.13 [11.93 – 12.33]), low birth weight (PR 17.8 [17.6-18.0] for the first and PR 20.1 [19.8-20.3] for the second twin), and low Apgar score (PR 2.9 [2.8-3.0] for the first and PR 2.7 [2.6-2.8] for the second twin) were the most important perinatal outcomes associated with twin pregnancies. A 5-minute Apgar score < 7 among twins was associated with inadequate prenatal care, extreme preterm birth, vaginal delivery, intrapartum cesarean, and combined delivery. Twin pregnancy in Brazil is associated with worse perinatal outcomes, especially for the second twin.

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

1982 ◽  
Vol 31 (3-4) ◽  
pp. 149-155 ◽  
Author(s):  
Xavier De Muylder ◽  
Jean-Marie Moutquin ◽  
Marie Françoise Desgranges ◽  
Bernard Leduc ◽  
Francisco Lazaro-Lopez
Keyword(s):  
Mortality Rate ◽  
Preterm Delivery ◽  
Perinatal Care ◽  
Fetal Mortality ◽  
Neonatal Deaths ◽  
Complete Extraction ◽  
Before And After ◽  
Twin Pregnancies ◽  
Second Twin ◽  
Spontaneous Delivery

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.

scholarly journals Perinatal Outcome of Twins Delivered Vaginally in a Tertiary Care Hospital

2021 ◽  
Vol 25 (1) ◽  
pp. 66-71
Author(s):  
Ayesha Zulfiqar ◽  
Maliha Sadaf ◽  
Amina Abbasi ◽  
Sabeen Ashraf ◽  
Omair Ashraf
Keyword(s):  
Intensive Care ◽  
Apgar Score ◽  
Perinatal Outcome ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Descriptive Study ◽  
Obstetrics And Gynaecology ◽  
Nicu Admission ◽  
Twin Pregnancies ◽  
Second Twin

Objective: To determine the perinatal outcome of first and second twin delivered vaginally in terms of frequency of poor APGAR score and NICU admission in the patient at term in a tertiary care health facility.Introduction: This study aims to improve the perinatal outcome of twin pregnancies through awareness of the need for antenatal care, the recommendation of regular antenatal visits, early recognition of complications, and the presence of neonatal intensive care facilities to improve neonatal outcome by knowing the burden of adverse outcomes in our population.Materials and Methods: This is a descriptive study, conducted at the Department of Obstetrics and Gynaecology at DHQ Hospital, Rawalpindi from January 2019 to June 2019.A total of 91 individuals (female pregnant ladies) who delivered twins (Dichorionic Diamniotic) babies through normal vaginally were selected for descriptive study in the Department of Obstetrics and Gynaecology, DHQ hospital Rawalpindi. All consecutive patients admitted in the labour ward with twin pregnancies were included. Before delivery, the fetal wellbeing of both the twins was evaluated also by ultrasonography. Data collection was done by interview schedule from the patients. Data were analyzed using descriptive statistics using SPSS version 17. For all the quantitative variables like age, gestational age and intertwine interval in seconds.Results: Out of 6278 deliveries during the study period, 91 twin births gave a frequency of 15.16/1000 births. Patients' mean age was 30.14+2.64 years, and mean gestational age was 37.47+0.72 weeks. The mean inter twin delivery interval (mins) in the study was 23.74+4.75. Perinatal outcome of first and second twin in terms of frequency of poor APGAR score and NICU admission in a patient at term was 09 (9.9%) and 27 (29.7%), (p<0.001) respectively.Conclusion: The study concludes that there was a high risk of perinatal outcomes in the second twin as compared to the first twin delivered vaginally. Poor Apgar score and neonatal intensive care admission were more so for the second twin.  

Perinatal Deaths in Twin Pregnancy: A 22-Year Review

1988 ◽  
Vol 37 (1) ◽  
pp. 47-54 ◽  
Author(s):  
R.H. Lumme ◽  
S.V. Saarikoski
Keyword(s):  
Perinatal Mortality ◽  
Twin Pregnancy ◽  
Distress Syndrome ◽  
Preterm Births ◽  
Central Hospital ◽  
Perinatal Deaths ◽  
Neonatal Deaths ◽  
Obstetric Management ◽  
Twin Pregnancies ◽  
Early Neonatal Deaths

AbstractChanges in the management of 1120 twin pregnancies delivered in Tampere University Central Hospital during the years 1964-1985 were studied, together with changes in the pattern of perinatal deaths. Perinatal mortality decreased from 7.4% in 1964-68 to 3.5% in 1981-85. There were no significant changes in stillbirths. The decrease of perinatal mortality resulted from a reduction in early neonatal deaths, mainly those due to respiratory distress syndrome. Changes in obstetric management include earlier diagnosis by ultrasound, intrapartum monitoring, and an increase in cesarean section rate from 4% to 32%. There is still a need for a reduction in the number of very early preterm births, and for more effective intrauterine supervision of twin pregnancies.

scholarly journals Feto-Maternal Outcome of Pregnancy Complicated with Preeclampsia

2020 ◽  
pp. 44-48
Author(s):  
Qaiser Javed Iqbal ◽  
Ayesha Javed ◽  
Zafar Ali Marri ◽  
Nadia Sabeen
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Maternal Mortality ◽  
Perinatal Mortality ◽  
Hellp Syndrome ◽  
Cross Sectional Study ◽  
Outcome Variable ◽  
Cross Sectional ◽  
Low Birth Weight Babies ◽  
The Mean

Pre-eclampsia is the disorder of extensive vascular endothelial malfunctioning and vasospasm. Both pregnant females and her fetus can develop different complications in the presence of preeclampsia. So we conducted this descriptive cross-sectional study to find the frequency of fetal and maternal outcomes in females having pre-eclampsia. After meeting the inclusion criteria 200 females were enrolled. Patients were followed from 32 weeks of gestation till the end of pregnancy. Inclusion and exclusion criteria were strictly followed. The outcome variable was recorded as per operational definitions. All patients were efficiently managed as per standard protocols. All the data was entered and then analyzed in SPSS v. 22. In this study the mean age of the patients was 28.93 ± 6.75 years, the mean BMI of the females was 27.46 ± 1.48 kg/m2. Partial HELLP syndrome noted in 51 (25.5%) females, maternal mortality occurred in 17 (8.5%) females, while eclampsia, prematurity, perinatal mortality and low birth weight were noted in 26 (13%), 106 (53%), 35 (17.5%) and 78 (39%) females respectively. This study concluded that the most common fetomaternal outcome was prematurity, low birth weight babies, partial HELLP syndrome, perinatal mortality, eclampsia and maternal mortality in patients with pre-eclampsia.

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