ABSTRACT
Objective: To evaluate the prognosis of the second twin according to different criteria [presentation, mode of delivery, term, weight, weight difference between twins ,twin to twin delivery time interval, studying the Apgar scores at birth and neonatal morbidity and mortality
Materials and Methods: This is a retrospective study of 183 parturients carrying twin pregnancies collected at the department of Obstetrics-Gynecology in Mahmoud Matri Hospital [Ariana] over a period of 9 years [1st January 2001 to 31st December, 2009]
Results: We recorded 357 live births [181 J1 and J2 176] and 9 stillbirths. The relationship between the order of the twin and the modality of delivery on the one hand, and between the order of twin and type of presentation was considered significant [p < 0.001]. We found no significant difference in Apgar score at 1 minute and 5 minutes between the 1st and the 2nd twins. A term = 34 weeks was a poor prognostic factor for the Apgar score at the first and the fifth minute for the 2 twins but no significant difference between the 1st and 2nd twins [1st min p=0.4623; 5th min p = 0.2899]. Low birth weight = 1500g were significantly more at risk of foetal suffering [p < 0.001]. A birth weight discordance of 25% or more was observed 36 cases [19.7 %]. The Apgar score was significantly influenced by the birth weight difference only in the first minute [p = 0.043]. Thereafter, this difference disappears in the 5th minute. The type of presentation and methods of delivery did not influence significantly the second twin morbidity. A time interval between the birth of the first and second twin greater than 15 minutes was a bad prognostic factor for the Apgar score in the 1st min [p = 0.001] and 5th min [p = 0.019]. Transfer rate in neonatology and neonatal distress was 31.2 %.The term of birth [ before 34 weeks], low birth weight [= 1500 g], and twin-to-twin delivery time interval [ >/= 15 min] are parameters that influenced significantly the rate of neonatal distress and transfer to pediatric health care unit [p <0.001, p<0.001, p = 0.004]. We found a significant increase in the transfer to pediatrics when the birth weight difference was larger than 25% [p = 0.005]. However, no significant difference was found concerning the neonatal respiratory distress [p = 0.22]. The different modes of delivery and the type of presentation of the second twin did not significantly alter the rate of neonatal respiratory distress [p = 0.28, p = 0.53] and transfer Pediatrics [p = 0,63, p = 0.38 ]. Among the live births, 5 twins had died in labor room: 1st twin in two cases and in 2nd twin in 3 cases and there was no significant correlation between neonatal mortality and the twin's order [p = 0.629]
Conclusion: A term = 34 weeks, a low birth weight = 1500g and a delay of more than 15 mn were factors that influenced significantly the Apgar score at 1st and 5th minute, and were responsible for more neonatal distress and transfer in pediatrics. A birth weight difference larger than 25% between the two twins influenced the Apgar score at the first minute and was responsible for an increase in the transfer rate