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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.
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Introduction: The incidence of twinning has been increasing due to availability and increased use of ovulation inducing drugs and 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. Material and methods: 106 cases of twin pregnancy fulfilling of age 18 - 35 years, at more than 32 weeks gestation, first twin with cephalic presentation and selected for vaginal delivery were included in the study. Intrauterine death of either one of the twins before the onset of labour, pregnancies complicated or fetal malformations and those with contraindication to vaginal birth were excluded. After thorough screening of included cases delivery was performed according to fixed protocol. After delivery, mode of delivery, cry, APGAR score, birth weight, complications, birth injury, time interval between deliveries, NICU admission and condition on discharge of each baby was noted. Results: 106 twins were included as delivered vaginally, including 3 patients who were delivered by vaginal delivery for 1st twin followed by caesarean delivery for 2nd twin. Stillbirth and early neonatal deaths resulted in 24 deaths. There is no significant difference between mortality of 1st and 2nd born twins. The neonatal mortality was equal in first and second twin. Neonatal morbidity was more in 2nd twin than 1st twin (27.65% v/s 15.95%). There were 41 NICU admissions (19.34%), out of those 36.6% were for first twin (n=15) and 63.4% for second twin (n=26), (p value 0.056). Incidence of RDS, invasive ventilator support, NICU Stay >7 days is significantly higher in second twin as compared to first twin. Breech presentations were associated with 10% neonatal mortality for second twin compared to none for first twin. Most common group for neonatal mortality and morbidity was birth weight 1000-1499 gm. Neonatal morbidity was 100% for discordancy 30 to 40% group while 85.71% for discordancy 20 to 30% group. These results are significant when compared for heavier twin v/s lighter twin (p value 0.001).Neonatal mortality and morbidity between first and second twin is statistically significant when compared according to Apgar score (p value 0.037). Incidences of stillbirth + early neonatal death for 2nd twin less in early preterm group but increased in in late preterm group. Neonatal outcome of 2nd twin was better in dichorionic pregnancies 11% v/s 16.67% in monochorionic pregnancies (p>0.05). Conclusion: Twin vaginal delivery is safe in first cephalic presentation in twin pregnancy. Caution should taken while delivering babies < 1500 gm, birth discordancy > 20% , gestational age < 34 weeks, as vaginal delivery in these conditions is associated with increased early neonatal morbidity and neonatal mortality.
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OBJECTIVE: The purposes of this study were to estimate the success rate of vaginal delivery after trial of labor (TOL) and to analyze the neonatal outcome of vertex-vertex (V-V) and vertex-nonvertex (V-NV) second twin according to the mode of delivery. METHODS: We reviewed retrospectively the medical records of V-V and V-NV twin delivered between December 1996 and February 2006. The patients were classified as TOL group and elective cesarean delivery (ECD) group to compare of the neonatal morbidity and mortality in second twin. Neonatal morbidity included intraventricular hemorrhage, respiratory distress syndrome, disseminated intravascular coagulopathy, sepsis, necrotizing enterocolitis, and birth trauma. Student t-test, Mann-Whtiney U test, Pearson's chi-square, and Fisher's exact were performed for the comparison of the neonatal outcome in second twin according to the groups. RESULTS: There are 349 eligible cases within given period. The proportions of TOL and ECD were 49% (n=170) and 51% (n=179), respectively. The success rates of vaginal delivery after TOL were 75% (n=93) in V-V twin and 70% (n=32) in V-NV twin. There were no significant differences in the neonatal outcome between TOL and ECD group. Additionally there were no significant differences in the neonatal outcome between cesarean delivery after the failure of TOL (n=45) and ECD group. CONCLUSION: Our results suggest that TOL in V-V and V-NV twin may be a safe method and can reduce the rate of ECD without adverse effect on neonatal outcome of second twin unless there are other obstetrical indications for cesarean delivery.