scholarly journals Epidemiological, clinical, prognostic and therapeutic aspects of twin delivery in two referral maternity units in Dakar (Senegal)

2018 ◽  
Vol 7 (2) ◽  
pp. 364
Author(s):  
Omar Gassama ◽  
Magatte Mbaye ◽  
Aminata Niass ◽  
Diodio Boye ◽  
Babacar Biaye ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Twin Pregnancy ◽  
Placenta Previa ◽  
Uterine Cavity ◽  
Breech Presentation ◽  
Premature Delivery ◽  
Time Interval ◽  
Maternal Complications ◽  
Twin Delivery ◽  
Second Twin

Background: Twin pregnancy is the simultaneous development of two embryos and then two fetuses in the uterine cavity. Objective of present study was to assess the epidemiological, clinical, prognostic and therapeutic aspects of twin delivery in two referral maternity units in Dakar.Methods: A descriptive and analytical retrospective bi-centric study of all cases of twin deliveries recorded in two referral center in Dakar was conducted during the period January 1st, 2005-December 31st, 2015, i.e. an 11-year period. It concerned 619 pregnant women who gave birth to twins in these two referral medical structures. The epidemiological parameters, clinical, prognostic and therapeutic aspects of twin childbirth were studied. The data were entered and analysed using Epi info version 3.5.3.Results: The twinning prevalence was 1.11%. The majority of our parturient women (506 or 81.7% of the cases) came from the Dakar suburbs. The average age of the parturient women was 28 years and the gestity age 3.1. Pregnancy was well monitored for 98.5% of the parturient women with an average number of prenatal consultations of 3.6. The first prenatal consultation was performed in 52% of cases in the first quarter. In more than one third of cases (234 or 37.8%), the diagnosis was made in the third quarter of pregnancy. 113 cases (18.2%) of premature rupture of membranes, 10 cases (1.61%) of threat of premature delivery and 7 cases (11.13%) of placenta previa were registered. During labour, the diagnosis was made by clinical examination in 32.2% of cases. Bichorial biamniotic twin pregnancy was the most frequent anatomical type (62.6%). On admission, the first twin (T1) was in cephalic presentation in 56.7%, in breech presentation in 15.2%; The second twin (T2) was in breech presentation in 21.1% of the cases. Caesarean section was related to the first twin in 50.6% and the second twin in 53.8% of the cases. Caesarean section was performed in 50.6% for the first twin and in 53.8% for the second twin. The mean time interval between the delivery of T1 and that of T2 was 17.4 min. Low birth weight was more frequent for the second twin (54.3%). The stillbirth rate was 48.26 per thousand. Maternal complications were dominated by renal-vascular syndromes (4.2%), haemorrhagic causes (1.86%), perineal lesions (1.6%) and uterine rupture (0.97%). Postpartum haemorrhage was observed in 8 cases (1.29%). Maternal mortality was nilConclusions: Twin delivery poses varying difficulties due to the complexity of obstetrical mechanics and the frequency of dystocic presentations. Despite improved maternal prognosis, in recent years, perinatal mortality and morbidity, still high, remain a constant concern.

scholarly journals Outcome of Twin Pregnancy in a Periurban Hospital

2016 ◽  
Vol 27 (2) ◽  
pp. 57-62
Author(s):  
Saria Tasnim ◽  
FM Anamul Haque ◽  
Sameena Chowdhury
Keyword(s):  
Birth Weight ◽  
Twin Pregnancy ◽  
Perinatal Death ◽  
Post Partum ◽  
Mode Of Delivery ◽  
Labor Pain ◽  
Maternal Complications ◽  
Management Options ◽  
History Of ◽  
Second Twin

Objective: To determine the socio demographic characteristics, clinical presentation and obstetric outcome at delivery and immediate postpartum period of twin gestation in a periurban hospitalMaterial & Methods: An observational study was conducted between January 2000 to December 2004 at Institute of Child and Mother Health. All twin pregnancy irrespective of gestational age admitted in the in-patient department of Institute of Child and Mother Health for delivery and also those undiagnosed cases found to have twin birth were enrolled in the study consecutively from January 2001 to December 2004. Data on socio-demographic factors, predisposing factors for twin gestation and obstetric characteristics was collected using a structured questionnaire. Hospital records were consulted for recording the investigation reports and management options. The outcome variables were maternal complications during antenatal, intranatal and immediate postnatal period, mode of delivery, birth weight and sex of newborn and fetal outcome. All twin pregnancies from the admitted obstetric patients were enrolled consecutivelyResults: During the study period there were 11,185 deliveries and among them 107 were twin gestation. About 22% were primigravida, 78.5% multigravida, 27.1% were illiterate. Most common age group were 24-29 years (39.4%). Antenatal care was availed by 71% of patients and 27.1% twins were not diagnosed till delivery. Family history of twin on maternal side was present in 58.1% and 31.8% had history of taking oral contraceptive immediately before the pregnancy. Ovulation inducing agents were given to 8.3% of twin. Presentations of fetus were both vertex 54.2%, 1st vertex and second breech 16%, and both breech 5.7%. About 55.1% were admitted with labor pain, 6.5% were undelivered second twin. Preterm birth was 27.2% and low birth weight of 1st baby 79.6% and second baby 80.9% respectively. Mode of delivery was vaginal delivery of both fetus 41.6%, caesarean section of both fetus 62.4%, and caesarean for second twin 3.1%. Same sex of both twins was found in 78% and male-male pair was 50%. There was one stillbirth, one conjoined twin and perinatal death was 11.2% Complications encountered during perinatal period were severe abdominal pain 9.3%, retained placenta in 7.3%; and post partum hemorrhage in 4.6% cases.Conclusion: Twin pregnancy is quite common and warrants specialized care during ante partum, intrapartum and postpartum period.Bangladesh J Obstet Gynaecol, 2012; Vol. 27(2) : 57-62

scholarly journals Caesarean section: its rates and indications at a tertiary referral center in Eastern Nepal

1970 ◽  
Vol 9 (3) ◽  
pp. 179-183
Author(s):  
S Chhetri ◽  
U Singh
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Placenta Previa ◽  
Caesarean Section Rate ◽  
Breech Presentation ◽  
Fetal Distress ◽  
Tertiary Referral ◽  
Common Indication ◽  
Tertiary Referral Center ◽  
Referral Center

Background: There has been a sustained increase in the rate of caesarean section in the last few years around the world. Data regarding the current caesarean rate and the trends of its indications in eastern Nepal have not been estimated earlier. Aim: To assess the rate of caesarean sections and the varying indications for caesarean section in a tertiary referral center in eastern Nepal. Methods: All hospital deliveries that took place in BPKIHS between January 2006 and December 2007 were recorded to assess the caesarean section rate and its indications. Results: A total of 5330 deliveries were conducted in 2006. Likewise the total number of deliveries conducted in 2007 was 6634. In 2006 caesarean sections were performed in 28.6% (1524) of all patients. The rate of caesarean sections in 2007 increased and was 33.7% (2239). The most common indication for caesarean section was meconiumstained liquor, which constituted 23.4% (883). The next frequent indication was previous caesarean section, which accounted for 17.2% (650), followed by breech presentation in 11.1% (417), fetal distress in 9.6% (364), non-progress of labor in 7.2% (270), cephalopelvic disproportion in 6.2% (234, and placenta previa in 4.4% (165). Conclusions: There is a increasing trend of performing cesarean section in the tertiary referral center in east era Nepal. The most common indication for cesarean section is meconium-stained liquor. Keywords: Caesarean section; caesarean delivery rates; Nepal DOI: http://dx.doi.org/10.3126/hren.v9i3.5587   HR 2011; 9(3): 179-183

scholarly journals Beating the Record: 157 Days of Delayed Delivery of The Second Fetus in a Twin Pregnancy

2020 ◽  
pp. 1-4
Author(s):  
Lourdes Sala Climent ◽  
D. Borniquel Agulló ◽  
F. Xavier González Tallada ◽  
I. Llordella Sarmiento ◽  
Javier Medrano Juárez ◽  
...  
Keyword(s):  
Twin Pregnancy ◽  
Second Step ◽  
Premature Delivery ◽  
Close Monitoring ◽  
Cervical Cerclage ◽  
Healthy Baby ◽  
Intraamniotic Infection ◽  
History Of ◽  
Management Choice ◽  
Second Twin

Case Report: We present the case of a diamniotic-dichorionic twin pregnancy of 14+4 weeks with obstetric history of cervical incompetence. The premature delivery of the first twin took place, with unfortunate outcome. The second twin was left in utero. The management, at first, included combination of expectant attitude with a close monitoring of maternal constants and analysis, and administration of antibiotics; in a second step, after discarding intraamniotic infection, a McDonald cerclage was performed with success. At 37 weeks the cerclage was removed and after Oxytocin induction, a healthy baby was born. Conclusion: Delayed delivery of the second fetus in a twin pregnancy is an effective management choice. The use of cervical cerclage after the first delivery is associated with a longer inter-delivery interval. The behaviour in these unusual cases should be assessed individually, due to the scarce literature on the matter and the lack of unanimous protocols. But, always considering the maternal and fetal status, trying to improve perinatal results with a strict maternal surveillance to discard the appearance of a possible intraamniotic infection.

scholarly journals CAESAREAN SECTION

2018 ◽  
Vol 25 (07) ◽  
Author(s):  
Saeeda Bano ◽  
Myda Muzaffar ◽  
Masooma Zafar ◽  
Fareeha Yousaf
Keyword(s):  
Caesarean Section ◽  
Teaching Hospital ◽  
Placenta Previa ◽  
Breech Presentation ◽  
Fetal Distress ◽  
Obstructed Labor ◽  
Cross Sectional ◽  
Medical College ◽  
Life Saving ◽  
The Ideal

Introduction: Caesarean Section (CS) is a surgical procedure carried out for thedelivery of the baby when circumstances render the possibility of a safe vaginal birth. Thoughcaesarean section can be life-saving in many situations, its unnecessary use has become a globalhealth concern. For almost 3 decades, the ideal rate for caesarean sections was consideredto be between 10% and 15% but its consistently increasing frequency over the past years hasbrought it to limelight. Objective: To determine the frequency and indications of Caesareansection at DHQ Teaching Hospital, Sahiwal. Study Design: A Cross-sectional descriptive study.Setting: Department of Gynaecology and Obstetrics, DHQ Teaching Hospital, Sahiwal affiliatedwith Sahiwal Medical College, Sahiwal. Period: It was carried out over a period of 6 monthsfrom December, 2016 to May, 2017. Methods: All the caesarean sections carried out during thestudy duration were included. Both maternal and fetal indications were recorded. The patientsnot willing to participate were not included. Results: Out of the total, Caesarean Sectionaccounted for 44.7% of the total deliveries. 72.05 % were elective and 27.49% were emergencyprocedures. Most Common Indications were found out to be previous >2 C-Sections (36.4%),previous 1 C-Section (28.3%). Rest of them were breech presentation (2.69%), obstructed labor(1.68%), fetal distress (2.6%), placenta previa (8.08%), APH (2.02%), post-dated pregnancy(4.04%), uterine rupture (7.56%) and others (6.58%). Conclusion: It was concluded that >2previous C-Sections is the most common indication. The high frequency should be controlledby proper counselling and education of the mothers and families, regarding the complicationsof caesarean section.

scholarly journals Successful Obstetrical Management of Over 100-day Interval between the First and Second Twin Delivery in an Infertility-Treated Patient: Counseling and Management Approach to Extreme Asynchronous Twin

2012 ◽  
Vol 3 (3) ◽  
pp. 97-101
Author(s):  
Tejshree Anurag Singh ◽  
Abha Majumdar
Keyword(s):  
Treated Patient ◽  
Male Infant ◽  
Premature Delivery ◽  
Management Approach ◽  
Patient Counseling ◽  
Female Fetus ◽  
Twin Delivery ◽  
Obstetrical Management ◽  
Counseling Approach ◽  
Second Twin

ABSTRACT Background This report describes a patient counseling approach, conservative and surgical management (cervical cerclage) of a dichorionic-diamniotic twin pregnancy, where delivery of the second twin followed the delivery of the first by 104 days. Case presentation A 35-year-old Indian lady, with 10 years of primary infertility, conceived twins, following ovulation induction with gonadotropin therapy. At 19 weeks and 4 days gestation, she aborted a female fetus of 410 gm. Tocolytic therapy was initiated; the placenta remained in situ and the umbilical cord of twin A was ligated high and McDonald's cerclage was placed and prophylactic antibiotics initiated. But since the patient's uterus continued to be irritable and the cerclage appeared to be under tension, at 20 weeks 6 days the stitch was taken out and all conservative treatment stopped for 24 hours, but reinitiated after this period, since the uterus remained quiescent. After 3 weeks of uterine inactivity, at 23 weeks 6 days gestation, McDonald's suture was reapplied following which conservative management was offered after counseling for possible risks associated with maternal sepsis, coagulopathy, need for extended hospitalization and potential for hysterectomy. Reassuring fetal status was observed for twin B without evidence of contractions or chorioamnionitis. A viable male infant (1,800 gm) was delivered vaginally at 34 weeks and 4 days gestation. Conclusion This report outlines a counseling approach useful for patients with premature delivery of one twin, and presents application of conservative obstetrical management principles for the aftercoming twin, even when delivery interval is extreme. How to cite this article Singh TA, Majumdar A. Successful Obstetrical Management of Over 100-day Interval between the First and Second Twin Delivery in an Infertility-Treated Patient: Counseling and Management Approach to Extreme Asynchronous Twin. Int J Infertility Fetal Med 2012;3(3): 97-101.

scholarly journals Short term perinatal outcome and their correlates among retained second twins, 15 years' retrospective study from northern Tanzania

2020 ◽  
Author(s):  
Zakaria Abdi Masoli ◽  
Eusebious Maro ◽  
Gileard Masenga ◽  
Benjamin C Shayo ◽  
Bariki Mchome
Keyword(s):  
Intensive Care ◽  
Caesarean Section ◽  
Perinatal Outcome ◽  
Neonatal Intensive Care ◽  
Perinatal Death ◽  
Apgar Scores ◽  
Intensive Care Admission ◽  
District Hospitals ◽  
Twin Delivery ◽  
Second Twin

Abstract Background : Second twin delivery has been associated with poor perinatal outcome such as birth asphyxia ,neonatal ICU admission and perinatal death in comparison to the first twin. There is limited information on the perinatal outcome of second twin in Tanzania. This study aimed at determining the perinatal outcome associated with second twin delivery in a tertiary hospital in Northern Tanzania.Methods: A retrospective cross-sectional study was conducted in a Tanzanian northern zone tertiary health facility using existing maternal linked data from medical birth registry. Women with twin deliveries from 2000 to 2015 were recruited. Adverse perinatal outcomes associated with second twin deliveries were estimated using multivariable logistic regression models. A p-value of < 0.05 was considered statistically significant. Results : Retention rate of second twin was 18.6% (n=265). Out of the 265 retained second twins, 54.7% were referral cases, majority of which came from district hospitals. Retained second twins had 1.54 ( 95% CI 1.08-2.20) and 2.49( 95% CI 1.14-5.48) higher odds of lower Apgar scores in the 5 th minute and perinatal death when compared to non-retained twins respectively. Referral cases had poor outcome compared to non-referrals. Retained twin who had caesarean section had lower odds of low Apgar scores in the 5 th minute, perinatal death and Neonatal intensive care admission although this was not statistically significant but clinically significant. Conclusion : Rate of retained second twin is high in this setting, most of which are referral cases. The retained second twin is associated with higher risk for perinatal death and low Apgar score in the 5 th minute. Timely delivery by caesarean section has lower chances of perinatal death, Neonatal intensive care admission and low Apgar scores. Therefore, early diagnosis and/or referral of twin pregnancy coupled with timely and appropriate intervention for delivery of the retained second twin will contribute to reduction in perinatal morbidity and mortality.

scholarly journals 100% Caesarean Section (CS) for Twin Pregnancy does Not Put the Second Twin at Disadvantage

2011 ◽  
Vol 70 ◽  
pp. 715-715
Author(s):  
C Proietti Pannunzi ◽  
M L Palazzi ◽  
R D'Ascenzo ◽  
F Staffolani ◽  
S R Giannubilo ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Twin Pregnancy ◽  
Second Twin

scholarly journals JUSTIFICATION OF CONTROL OF RECEVALESCENCE AND INDIVIDUAL REHABILITATION IN WOMEN WHO UNDERWENT SEVERE PREECLAMPSIA

2018 ◽  
Vol 25 (3) ◽  
pp. 73-81
Author(s):  
V. A. NOVIKOVA ◽  
Z. S. YUSUPOVA ◽  
O. A. SHAPOVALOVA ◽  
V. A. KHOROLSKY
Keyword(s):  
Assisted Reproductive Technologies ◽  
Diastolic Pressure ◽  
Multiple Pregnancy ◽  
Uterine Cavity ◽  
Reproductive Technologies ◽  
Severe Preeclampsia ◽  
Premature Delivery ◽  
Time Interval ◽  
Interstitial Pulmonary Edema ◽  
Perinatal Center

Aim. Justification of control of reconvalescence and individual rehabilitation in women who underwent severe preeclampsia (PE). Materials and methods. A prospective, non-randomized, controlled, open-label, nosocomial study was conducted in the period of 2016-2017. 170 women participated: 100 women with severe preeclampsia (32 – with early, 68 – with late), 70 women with moderate preeclampsia. Inclusion criteria: pre-eclampsia, singleton pregnancy, which occurred spontaneously in the natural menstrual cycle. Exclusion criteria non-obstetric pathology, by competing with the severity of pre-eclampsia, multiple pregnancy without fetal cephalic presentation, pregnancy due to assisted reproductive technologies, obstetrical pathologies, necessitating premature delivery or emergency. Results. In 70% of women the gestational age was premature. 53% of women with PE were primiparous and primgravida. Due to the atypical course of PE the time interval from the suspicion of PE to its clinical verification and delivery could reach 35 days, on average – 5,88±8,76 days before being transferred to the perinatal center. Time spent in the Perinatal Center before delivery was 3.43±2.3 days for early PE, 1.9±2.28 days for the severe late PE and 3.29±2.36 days for mild PE, was comparable. In women with severe PE critical (urgent) dysfunction of the organ (s) were diagnosed: signs of moderate pulmonary hypertension, interstitial pulmonary edema, hydrothorax; stagnant phenomena of both lungs; moderate hydrocephalus; dilatation of the left atrium; diffuse changes in the liver, pancreas, kidney parenchyma; paranephric discharge; hydroperitoneum; hydrothorax; hydropericardium. Critical multiple organ disorders due to PE in combination with delivery by cesarean section after delivery demanded staying in the intensive care ward within 2.6±1.84 days in severe PE and 1.0±1.41 days in moderate PE (p>0.05). 24% of women with severe PE after delivery under the supervision of ultrasound performed a vacuum-aspiration of the contents of the uterine cavity. The maximum time spent in the Perinatal Center after delivery was 7.65±2.34 days (5-13 days). The outpatient visits to an obstetrician-gynecologist varied from the 7th to the 15th week after the delivery. In 26% of women changes remained in the fundus (retinopathy, retinal angiopathy) and 35% - neurological symptoms (encephalopathy) of varying severity. In 16% of women d arterial hypertension with values of diastolic pressure more than 90 mm Hg was preserve. Conclusion. It is necessary to ensure the rehabilitation of women who have undergone severe PE, not only after delivery in a perinatal center, but also at an outpatient stage under supervision of related specialists. In the presence of fertile plans, individualized pregravid and preconception preparation is required with consideration of the nature of the scar on the uterus undergone instrumental uterine evacuation, specialized supervision by related professionals.

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