RESUMO
Background: The incidence of twinning has been increasing due to assisted reproductive technology. Despite substantial concerns over the well-being of the second twin with regard to intra partum events, outcome studies on this issue are conflicting. Some have reported no increase in perinatal complications, while others showed significant associations between labor and delivery of the second twin and increased perinatal morbidity and mortality.Methods: All pregnant women of twin pregnancy at more than 28 weeks of gestation, first twin with cephalic presentation were selected for study. Intrauterine death of either of the twins, pregnancies complicated or fetal malformations and those with contraindication to vaginal birth were excluded. After delivery, APGAR score, birth weight, complications, time interval between deliveries, NICU admission and condition on discharge of each baby was noted.Results: Out of 106 women with twin pregnancy 89 of them delivered vaginally, there was statistically no significant difference of live births, still births, early neonatal mortality in the first and second born twins. Neonatal morbidity was more in the second twin than the first twin (23.33% versus 21.11%).Out of all NICU admissions 47.5% were for the first twin and 52.5% for the second twin.Conclusions: Twin vaginal delivery is safe in first cephalic presentation in twin pregnancy. Caution should be taken while delivering babies <1500gm, gestational age <34 weeks, as vaginal delivery in these conditions is associated with increased early neonatal morbidity and neonatal mortality.
RESUMO
Background: Preterm birth is a global health problem affecting the neonate, family and country in general. It is the leading cause of perinatal mortality and morbidity. Short cervical length detected on transvaginal ultrasound is the most practical risk factor for prediction of preterm birth. The aim of this study was to determine the efficacy and safety of vaginal progesterone in reducing the rate of preterm birth in women with a short cervix and to determine its effect on neonatal mortality and morbidity.Methods: The study was carried out in the Department of Obstetrics and Gynaecology at Assam Medical College, Dibrugarh for a period of one year. It included 128 asymptomatic women with a singleton pregnancy and a sonographic short cervix. Women were randomly divided into two groups, one of which was given placebo and the other was given vaginal progesterone and a comparative study was conducted.Results: It was observed that delivery before 37 weeks of gestation was less frequent in the progesterone group than in the placebo group (60.94% vs. 90.63%). Vaginal progesterone was also associated with a significant reduction in adverse neonatal outcomes like the rate of sepsis (6.25% vs. 18.75%), requirement of ventilator (12.5% vs. 26.56%), admission to NICU (10.94% vs. 26.56%) and birth weight ≤1.5kg (7.81% vs. 21.88%).Conclusions: Vaginal progesterone reduces the risk of preterm birth and adverse perinatal outcomes in pregnant women without any deleterious effects on the foetus or mother.