A randomized controlled trial of two-doses of vaginal progesterone 400 vs. 200 mg for prevention of preterm labor in twin gestations

Objectives To compare between the effectiveness and safety of two different daily doses of vaginal progesterone (400 vs. 200 mg) in the prevention of preterm labor in twin pregnancy. Methods This is a prospective single-blinded randomized controlled trial conducted on 100 primi-gravida who had twin pregnancy and attended the antenatal clinic of a University hospital. They were equally and randomly allocated into two arms each containing 50 patients. Arm 1 received 400 mg and arm 2 received 200 mg vaginal progesterone daily at bed time starting from 14 weeks of pregnancy to 36 weeks. Transvaginal ultrasound was performed for assessment of the length of cervix at 14 and 22 weeks. Results Both arms of the current study were comparable regarding the cervical length at 14 and 22 weeks, mean gestational age at delivery, incidence of pre-term delivery, birth weight of the first twin. Second twin in addition to the average weight of both twins. No statistical significance differences between two arms regarding incidence of early neonatal death. NICU, mechanical ventilation, length of admission in NICU for the first twin. Second twin as well as both twins. Conclusions Vaginal progesterone treatment with different doses was tolerable, but wasn’t effective in the prevention of preterm labor in twin pregnancy.

PERINATAL OUTCOME OF SECOND BORN TWIN

Background: The second twin is generally considered at higher risk of severe morbidity and mortality because of obstetric complications that may occur after delivery of the first twin. Methods: The hospital based descriptive type of observational study was conducted in the Department of Obstetrics and Gynaecology, Jhalawar Medical College, Jhalawar. Results: In 54.00% neonate APGAR score was 5-7 followed by 42.00% neonate APGAR score was >7 and 4.00% neonate APGAR score was less than 5. 84.00% delivery were ND followed by 14.00% delivery was AVBD and 2.00% delivery was IPV-BE. Conclusion: Second twin had low Apgar score and chance of neonatal admission was more. Keywords: NICU, APGAR score, Neonates.

Delayed-interval Delivery in Multiple Pregnancies: Short- and Long-term Outcome

Purpose Multiple pregnancies are at higher risk of preterm birth due to premature labor, cervical insufficiency, or premature rupture of membranes. However, both children do not necessarily have to be born and exposed to the morbidity of prematurity depending on the age of gestation. One option is a delayed-interval delivery with reduction of morbidity and mortality for the second twin, considering maternal morbidity. Methods Retrospective study of delayed-interval deliveries in multiple pregnancies with evaluation of short-and long-term outcome from 2003 to 2020 at the Women’s and Children’s Hospital of the University Hospital < blinded>. Results In 17 cases, the delivery of the second twin could be prolonged, on average for 36 days. Pregnancies with delivery of the first twin before 22 weeks of gestation had a longer prolongation than pregnancies with delivery of the first twin after 22 weeks (53 vs. 22 days). In cases where a cerclage was placed, on average a longer prolongation interval (45 vs. 19 days) was observed. The short- and long-term follow-up of the second twin is comparable to the usual complication rate of premature birth. Conclusion Multiple pregnancies endangered by premature birth can be successfully prolonged for the second twin without serious maternal morbidity. If the first twin is born before 22 weeks of gestation and a cerclage is performed afterwards, a longer prolongation interval appears.

OUTCOME OF SECOND BABY OF TWIN IN A RURAL TEACHING HOSPITAL OF WEST BENGAL, INDIA

Background: Multiple pregnancies are a high-risk situation because of its inherent risks to mother and the fetus. Twin or multiple pregnancies are gaining importance worldwide because of the attributable rise in treatment of infertility including assisted reproductive technologies. Twin pregnancies are associated with increased fetal loss, prematurity, structural abnormalities, and fetal growth restriction. Complications associated with twin pregnancy. The conduct of a twin delivery remains one of the most challenging events in the current obstetric practice. This Methods: study was an Hospital-based cross-sectional descriptive study conducted in the Department of Obstetrics & Gynaecology of Bankura Sammilani Medical College and Hospital, Bankura, West Bengal from January 2020 to December 2020. 238 patients were included in the study after informed consent from the patient about being a part of this study. Template was generated in MS excel sheet and analysis was done on SPSS software. Results: Majority 154 (64.7%) of women belonged to age group 21-30 years. Gestational age of 159 (66.8%) mothers were < 37 weeks. Perinatal outcome of second twin was highest in the maternal age group 20 years. Perinatal outcome of second twin was highest in the birth weight of the 2nd twin < 2500 grams. Delivery time interval between the babies was maximum 175 (73.5%) is < 10 minutes. Gestational age, Conclusions: presentation, mode of delivery, and birth weight are the signicant determinants of perinatal outcome of the second twin. The second twin is at higher risk of perinatal morbidity and mortality than the rst twin. Frequent antenatal care should be advised to the mothers.

Evaluation of the risk of umbilical cord prolapse in the second twin during vaginal delivery: a retrospective cohort study

ObjectiveThis study aimed to evaluate the success rate of vaginal delivery, the reasons for unplanned caesarean delivery, the rate of umbilical cord prolapse and the risk of umbilical cord prolapse in twin deliveries.DesignRetrospective cohort study.SettingSingle institution.ParticipantsThis study included 455 women pregnant with twins (307 dichorionic and 148 monochorionic) who attempted vaginal delivery from January 2009 to August 2018. The following criteria were considered for vaginal delivery: diamniotic twins, cephalic presentation of the first twin, no history of uterine scar, no other indications for caesarean delivery, no major structural abnormality in either twin and no fetal aneuploidy.ResultsThe rate of vaginal delivery of both twins was 89.5% (407 of 455), caesarean delivery of both twins was 7.7% (35 of 455) and caesarean delivery of only the second twin was 2.9% (13 of 455). The major reasons for unplanned caesarean delivery were arrest of labour and non-reassuring fetal heart rate pattern. The rate of umbilical cord prolapse in the second twin was 1.8% (8 of 455). Multivariate analysis revealed that abnormal umbilical cord insertion in the second twin (velamentous or marginal) was the only significant factor for umbilical cord prolapse in the second twin (OR, 5.05, 95% CI 1.139 to 22.472, p=0.033).ConclusionsAbnormal umbilical cord insertion in the second twin (velamentous or marginal) was a significant factor for umbilical cord prolapse during delivery. Antenatal assessment of the second twin’s umbilical cord insertion using ultrasonography would be beneficial.

Twin Vaginal Deliveries: Impact of Delivery Time Interval on Twin B

Background:A vaginal twin delivery is a natural commonplace occurrence, but which can sometimes present a concern which may require action. Recently, the delivery time interval has been recognized as a variable that can be helpful for its safe conduct.Objectives:To view the delivery time interval in an obstetric population undergoing a twin vaginal trial of labor in consecutive deliveries during a specified time period.Study Design:A retrospective observational cohort of twin vaginal trials of labor was investigated to view the delivery time interval and its association with other factors, such as birth weights and the need for cesarean delivery of the second twin. The twin deliveries were divided into 2 groups, those with a delivery time interval of ≤ 30 minutes (Group A) and those with a delivery time interval of > 30 minutes (Group B), in a single institution.Results:No perinatal outcome difference was found between Group A (248 patients) or Group B (72 patients). However, 13 patients in Group B required a cesarean birth for a safe delivery, and 3 patients in Group A. The birth weight difference between each Baby A and Baby B varied according to the delivery time interval. Conclusion:The delivery time interval for vaginal twin deliveries may be useful to predict the need for a cesarean delivery of the second twin. The birth weight difference between Baby A and Baby B may be responsible for this finding.

Disparities in Trial of Labor among Women with Twin Gestations in the United States

Objective The aim of the study is to examine clinical and demographic factors associated with trial of labor (TOL) among women with twin gestations eligible for a vaginal delivery. Study Design This was a population-based cohort study of women giving birth to twin gestations in the United States (2012–2014). Inclusion criteria for the analysis included live births greater than 23 weeks' gestation and a cephalic presenting twin. Women with prior cesarean delivery were excluded. Women were categorized by whether they underwent a TOL. Clinical and demographic characteristics associated with TOL status were evaluated using multivariable logistic regression analyses. Secondary analyses with stratification by parity and by second twin presentation were performed. Results Of 90,000 women eligible for inclusion, a minority (39.3%) underwent TOL. Women who had a greater gestational age at delivery were more likely to have a TOL. In contrast, several demographic factors were associated with decreased likelihood of TOL, including maternal age >35 years and identifying as Hispanic or Asian compared with non-Hispanic White. No differences in odds of TOL were observed for women who were identified as non-Hispanic Black versus non-Hispanic White, nor were other demographic factors such as marital status, insurance status, or educational attainment associated with undergoing TOL. Clinical factors associated with decreased odds of TOL included nulliparity, obesity, and hypertensive disorders of pregnancy. Results did not substantively change when stratified by parity or second twin presentation, nor did findings differ in the subgroup who delivered at 32 weeks of gestation or greater. Conclusion In this large population of women with twins who were eligible for a TOL, a minority of individuals attempted a vaginal delivery. Demographic and clinical factors such as older maternal age, Asian or Hispanic racial or ethnic identification, nulliparity, and obesity are associated with decreased odds of undergoing TOL. Key Points