​Perinatal Outcome of the Second Twin with Respect to Mode of Delivery – A Prospective Analysis

Aims and Objectives: The aim of the study was to study the perinatal outcome of the second twin with respect to mode of delivery.Materials and Methods: Consecutive pregnant women having twin pregnancies beyond 28 weeks of gestation admitted tothe department of the institute during the period from April 2016–May 2017 were included in the study.Results: A total of 50 cases were enrolled in the study. Vaginal, ventouse/forceps, and lower segment cesarean section (LSCS) werethe different modes of delivery consisting of 48%, 2%, and 50% of cases, respectively. Perinatal loss of the second twins was higher inLSCS group consisting of 61.11% of cases. Perinatal loss of the second twins was 100% for monochorionic monoamniotic pregnancieswhereas 33.33% for monochorionic diamniotic and 29.03% for dichorionic diamniotic pregnancies. The delivery time interval of <10 minbetween the first and second twin had the higher second twin perinatal loss, i.e., 37.14% and less poor APGAR score, i.e., 57.14% incomparison to time interval of 10–30 and >30 min groups but statistically insignificant. For second twin, vertex presentation had higherpoor APGAR score compared to non-vertex presentation, i.e., 65.63% versus 55.56%. Poor APGAR score was found to be higher incesarean section, outlet forceps and vaginal mode of deliveries consisting of 60%, 100%, and 62.5%, respectively. In overall, 64% ofsecond twins and 84% of first twins were alive, and the difference had P = 0.034. About 62% of second twins and 34% of first twinswere having poor APGAR score of <7, and the difference had P = 0.005. About 67.44% and 76.92% of second twins were found tobe alive higher in maternal age group of ≥20 years and multigravida group, respectively, having P < 0.05. About 64.52% and 100% ofsecond twins were alive higher in <37 weeks gestational age group and birth weight of second twin ≥2500 kg groups, respectively, withP < 0.05. Second twins were having higher alive in vertex-non-vertex presentation, vaginal mode of delivery for both the twins, DCDAgroup and intertwin delivery interval of 10–30 min groups consisting of 71.43%, 72%, 70.97%, and 77.78%, respectively, with P > 0.05.Conclusion: The perinatal mortality of 2nd twin is higher than that of 1st twin in terms of monochorionic, prematurity, and lowbirth weight. Intensive labor monitoring, safe delivery, and improved neonatal care facilities appear to be the major areas toimprove the perinatal outcome.

Evaluation of Acceptability, Safety, and Efficacy of Intrauterine Device Insertion during the Postpartum Period: A Prospective Analysis

Background: Intrauterine contraceptive devices (IUCD) are a rapidly reversible method of contraception. It is necessary toassess the acceptability and uptake of IUCD in parturients elaborating its safety and success.Aims and Objectives: The aim of the study was to evaluate the acceptability, safety, and follow-up of postpartum insertion ofIUCD both in vaginal and cesarean section deliveries among parturients with the ultimate goal is to avoid unplanned pregnanciesand to expand the usage of IUCD.Materials and Methods: The study was a prospective one conducted during the period of January 2014–January 2015. All theantenatal patients at their visits after 30 weeks of gestation were taken in the study and parturients accepted for postpartumIUCD (PPIUCD) insertion constitute the study population.Results: A total of 202 patients were included in the study population. Majority of cases accepted for PPIUCD had at leasta primary level of education, were primiparous, and had their last childbirth >2 years age consisting of 90.10%, 46.53%, and44.55%, respectively. About 27.72% of the parturients were aware of the PPIUCD and 58.91% of parturients accepted PPIUCDdue to its long-term effect. PPIUCD insertion done for the study was three types such as: Within 10 min, immediate (within 24 h),and trans-cesarean consisting of 23.76%, 15.35%, and 60.89%, respectively. About 96.04%, 79.70%, and 60.90% cases wereattaining for follow-up at 6 weeks, 3 months, and 6 months, respectively. At 6 week follow-up, pelvic inflammatory disease,irregular cycles, and pain were the chief concerns consisting of 34.16%, 23.27%, and 16.83%, respectively, whereas bleedingper vagina, lost string, and expulsion were less seen. PPIUCD expulsion was seen in 14.85% of the parturients.Conclusions: Awareness of the PPIUCD among women was poor despite high acceptance and needs strategies to increaseawareness. The PPIUCD was demonstrably safe, having no reported incidence of perforation with low rates of expulsion, pelvicinfection, and few lost strings.

Clinical experience of ovarian neoplasm in childhood and adolescence.

Clinical behaviour of 12 cases of ovarian neoplasm in childhood and adolescence was reviewed. Diagnostic work-up required a great deal of time, gentleness and patience. Of all ovarian tumours, 58.4% were epithelial, 33.3% were germ cell group and 8.3% were sex cord stromal tumours. Pleuripotent nature of gonads is reflected by the complex variety of ovarian tumours in children. Seventy-five per cent among the tumours were malignant. Amongst the epithelial tumours 85.7% were malignant. Because of certain reasons, comparison of results was felt difficult.

Diagnosis and management of foetal nomalies.

Prenatal diagnosis of foetal anomalies and their management by invasive and non-invasive techniques are discussed. Early diagnosis allows the parents to organise appropriate neonatal management for sublethal and correctable anomalies while termination of early pregnancy is an option for lethal anomalies.