Pregnancy Outcome and Factors Affecting Vaginal Delivery of Twins at University of Nigeria Teaching Hospital; Enugu

Objective: The study aims to determine the differences in maternal and perinatal outcomes between caesarean and vaginal deliveries and the factors affecting vaginal delivery in twin pregnancy.Materials and Methods: An observational study to audit twin pregnancies delivered at the University of Nigeria Teaching Hospital between 2002 and 2008. Clinical observations were entered into a questionnaire immediately after the delivery of the women and the mothers and their babies were followed up until the end of the puerperium.Results: There were 5298 deliveries within the study period; out of which 117 were twin deliveries. This gives a twinning rate of 22 per 1000 deliveries. The mean age of the mothers was 30 } 5.9 years. Twenty.five (21.4) women were admitted into the hospital for preterm labor. The average gestational age of admission was 32 } 5.8 weeks and the average duration of hospital stay for preterm labor was 12.6 } 9.1 days. Other pregnancy complications observed were severe hypertension (14.5; anemia (9.4); postpartum hemorrhage (8.5); puerperal fever (5.1); abruptio placentae; and diabetic mellitus (2.7). Fifty.nine women (50.4) had vaginal deliveries; 5 (4.3) had vaginal delivery of the leading twin and caesarean delivery of the retained second twin while 53 women (45.3) were delivered by caesarean section. Forty.eight (41) women had preterm delivery. Vaginal deliveries were more common than caesarean section among patients that were unbooked than booked P = 0.047 (OR 2.26; 95CI:0.93.5.53) and those that had cephalic presentation of the leading twin; P = 0.0002 (OR = 4.7 95 CI:2.6.8.2). Vaginal delivery tended toward statistical significance when the fetal weight of the leading twin was 1.5 to 2.5 kg; P = 0.09. The commonest indications for caesarean section were abnormal lies and presentations and hypertension in pregnancy.Two.hundred and seventeen (92.7) out of a total of 234 fetuses that were delivered in this study were live births and 17 (7.3) still births. The rate of new born admissions in twin 1 was however higher in those delivered by Caesarean section (39.6) than those delivered vaginally (29.7). Indications for admissions into the special baby care units were; prematurity 33 (40.2); birth asphyxia 15 (18.3); low birth weight 12 (14.6); neonatal jaundice 10 (12.2); and twin-twin transfusion 4 (4.9). There was a higher rate of early neonatal death in both vaginally delivered twin 1 (9.4) and twin 2 (11.9) than those delivered by Caesarean section; 3.8 and 3.5; respectively.Conclusion: Cephalic presentation of the leading twin; birth weight less than 2.5 kg; and unbooked women presenting in advanced labor predisposed to vaginal delivery in twin pregnancies. There was however increased risk of still birth and early neonatal deaths especially for the leading twin in vaginal deliveries in unbooked women

Successful Separation of Conjoined Pygopagus Twins in African Environment with Limited Resources

Conjoined twins are identical or monozygotic twins whose bodies are joined in utero. Pygopagus or Iliopagus twins are a type of conjoined twins in which two bodies joined back to back at the buttocks. Surgical separation of conjoined twins is extremely risk of death and life threatening. We report on cases of female pygopagus twins of three months operated and separated at Kigali University Teaching Hospital. For both babies a posterior sagittal anorectoplasty was successfully performed with derivated ileostomy. Despite limited resources to carry out such operation in our settings; no complications occurred during the operation and oral feeding was done at third postoperative day. Ileostomy closure was performed three weeks after and babies were discharged from neonatology unit at 35th postoperative day. In conclusion; adequate preoperative investigation with a well organized and trained team contribute a lot to the success of such conjoined twins separation

Incidence of Delivery of Low Birthweight Infants in Twin Gestations

Twin gestations are commonly associated with delivery of low birthweight infants. Despite the fact that Nigeria has the highest incidence of twinning in the world; there is paucity of information on the characteristics ofLBWtwin infants in Nigeria. To determine the incidence and document some of the characteristics of low birth weight (LBW) twin infants. Adescriptive analysis of data on 119LBWtwin infants delivered between 1st January; 2000 and 31st December; 2003 in a Nigerian mission hospital in Benin City was carried out. The characteristics of the LBW twin infants was studied in relation to perinatal mortality. The overall incidence of LBWtwin infants was 51.7with a female preponderance. Of the 107 liveborn LBWtwins; 74 (69.2) compared to 33 (30.8) were preterm and term small-for-gestational age (SGA) infants respectively (p

Congenital Hydrocephalus in Mono and Dizygotic Twins

Background: Information regarding the occurrence of hydrocephalus (HC) in twins is important in establishing the significance of environmental factors as well as a genetic basis in congenital HC aetiology. This was the basis for this study. Methods: A single institution retrospective study was conducted between August 1; 2006 and July 31; 2008. Only those cases of hydrocephalus (based on clinical and radiological testscranial Computeried tomographic or Magnetic resonance imaging scan) that required placement of a ventricular shunt or endoscopic third ventriculostomy were included in the study. Data regarding the patient's demographics; clinical history; examination and the maternal demographics were retrieved and analysed. DNA analysis was done to confirm the fraternity of the twins when applicable. Results: Fifty-eight patients with congenital hydrocephalus presented to the unit over the study period. We identified three sets of twins in the study. Only one set were identical (both male) and both had hydrocephalus. In the remaining two sets only one out of each pair had hydrocephalus (one male and one female). Two of the patients (1male; 1female) were twins with discordant HC. All the children had normal thumbs. DNA analysis confirmed identical twins in both the like sex twins. The mothers were not known diabetics; hypertensive or sickle cell patients neither did they smoke or take alcohol. There was no family history of hydrocephalus in all patients. Conclusion: Concordance for HC is likely if the twins are like sex and identical. Congenital hydrocephalus seems to be a multifactorial disorder; triggered by environmental factors in genetically predisposed individuals

Twin Delivery: Comparison of Incidence and Foetal Outcome in Two Health Institutions in Benin City; Nigeria

Background: The incidence of twin delivery in Nigeria may have changed; in view of the worldwide increase in the rates of twinning attributed to increasing maternal age and use of fertility therapies. Objective: To determine the current incidence of twin delivery in Benin City and document the foetal outcome in twins. Methods: A four-year descriptive (cross-sectional) study of twin deliveries in a Nigerian mission hospital was conducted. The foetal outcome in 115 sets of twin was compared with that of 230 singleton controls. Results: The current incidence of twin delivery was 25.3 per 1000 deliveries or one in 40 births; representing a reduction by 24.2. Sex ratio was 0.98 : 1 in favour of females. Seasonal variation was observed in the incidence of twin delivery with a significantly higher incidence in wet than in dry season p

Management of Conjoined Twins : a Report of Two Sets

Background: Conjoined twinning is a rare congenital anomaly. We present here; our experience in the management of two sets of conjoined twins at a Teaching Hospital in north central Nigeria. Method: Data of conjoined twins managed at the Jos University Teaching Hospital in 1987 and 2004 were retrospectively collated and analyzed. Result: Two sets of pyopagus tetrapus conjoined twins were managed within the period; one was a set of triplets. The conjoined pairs in both sets of twins were females. None of the twins was diagnosed prenatally. Both sets of conjoined twins were delivered spontaneously by vaginal route. Emergency surgical separation was undertaken in both sets be- cause of deteriorating anencephaly in one twin in the first set and anorectal malformation and intestinal obstruction in one twin in the second set. Both sets of twins died after separation. Conclusion: Our experience showed that separation of conjoined twins may be associated with high mortality. Sepsis and electrolyte imbalance appear to be the major causes of morbidity and mortality; particularly when the resultant skin defects are large

Intrauterine fetal death of one of the twins; coexisting with hydranencephaly in the surviving co-twin: A case report

Hydranencephaly; a relatively rare malformation of the brain; is characterised by absence of the cerebral hemispheres and their replacement by sacs filled with cerebrospinal fluid. It is one of the recognised forms of intracranial malformations associated with intrauterine fetal demise of one of twins in monochorionic twin gestation. This report illustrates the development of hydranencephaly in a surviving twin sequel to intrauterine fetal demise of the co-twin

Etude comparative de la mortalite perinatale des premiers et deuxiemes jumeaux (a propos de 198 cas colliges a la maternite du CHU de Cocody)

Notre travail est une etude transversale prospective et analytique realisee a la maternite du CHU de Cocody du 1er Fevrier 2002 au 31 Janvier 2003. Son but est d'apprecier les facteurs de risque de la mortalite perinatale dans l'accouchement gemellaire. Nous avons analyse 198 accouchements gemellaires de parturientes ayant accouche les deux jumeaux ou le deuxieme jumeau a la maternite du CHU de Cocody et compare le pronostic neonatal du premier et deuxieme jumeau.Nous constatons une influence nefaste sur le pronostic neonatal des facteurs suivants:-Absence de surveillance prenatale-Toxemie gravidique-Diagnostic tardif de la grossesse gemellaire-Prematurite-Presentations dystociques-Manoeuvres obstetricales sur le deuxieme jumeau-Allongement du delai entre les deux naissances-Faible poids de naissanceL'amelioration du pronostic neonatal passe par une surveillance prenatale obligatoire et rigoureuse; une realisation des accouchements gemellaires dans les centres specialises et equipes; une education sanitaire de nos gestantes

Les Siamois : Une curiosite scientifique: a propos d'un cas rapporte a l'hopital Gabriel Toure - Bamako

Il s'agit d'une variete de grossesse multiple; survenant au cours des grossesses gemellaires monochorioles; mono amniotiques. Elle touche environ 1 pour cent des jumeaux monozygotes. L'incidence est estimee a 1 cas pour 50;000 naissances. Nous rapportons ici 1 cas de siamois decouvert a la naissance de l'hopital Gabriel Toure. Le diagnostic antenatal de cette variete de grossesses multiples peut cependant etre pose grace a l'echographie; qui permet en outre d'envisage la prise en charge pediatrique; chirurgicale a la naissance