ABSTRACT
In a series of 220 consecutive twin deliveries, 10 second twins were delivered by caesarean section after vaginal birth of the first, but only six survived. The mean time-interval between the birth of twins was 68 minutes. Because a protracted interdelivery interval carries risks of placental separation and cervical contraction, prompt trial of version of the second twin followed by vaginal breech extraction under anaesthesia might improve perinatal outcome.
Subject(s)
Delivery, Obstetric/statistics & numerical data , Pregnancy Outcome , Twins , Apgar Score , Birth Weight , Cesarean Section/methods , Cesarean Section/statistics & numerical data , Delivery, Obstetric/methods , Female , Fetal Death , Humans , Labor Presentation , Pregnancy , Pregnancy Trimester, Third , Time Factors , Trinidad and Tobago/epidemiology , Version, FetalABSTRACT
An objective analysis of our clinical experience with the intrapartum management of twin gestations was undertaken in order to determine whether or not routine caesarean section is justified when the first twin presents by the breech. The perinatal mortality rate for breech first twins delivered vaginally was not statistically different from vertex presentations. There was no perinatal loss among babies delivered vaginally by the breech. There was no difference in perinatal outcome for the breech first twin born abdominally or vaginally. Our findings have allayed the fear that non-vertex vaginal delivery of the first or second twin is dangerous. We conclude that in the absence of a uterine scar or a footling presentation, there is no valid reason to prohibit vaginal delivery when either twin presents by the breech.
Subject(s)
Breech Presentation , Delivery, Obstetric/methods , Infant Mortality , Pregnancy, Multiple , Cesarean Section , Female , Humans , Infant, Newborn , Pregnancy , TwinsABSTRACT
A 7-year retrospective survey was conducted in order to determine local trends in caesarean section rates, maternal outcome and indications for the procedure. The annual rate of caesarean births has not exceeded 10.0% of deliveries. The overall rate, at 7.4% for the period of study, was not significantly different from that obtained a decade and a half ago. Significant procedure-related morbidity was uncommon. In view of preventable anaesthetic maternal deaths, a plea is made for an increased use of regional in preference to general anaesthesia in selected cases.
ABSTRACT
To test the hypothesis that obesity represents a risk factor in pregnancy, we conducted a prospective case-control study to determine whether or not there was any divergence in the obstetric outcome among 132 obese women from that in a control group of 136 non-obese patients. Obese mothers had an increased incidence of pregnancy-induced hypertension and gestational diabetes but there was no significant difference in the duration of pregnancy or in the frequency of low Apgar score at 1 minute. The favourable fetal outcome in obese parturients reflects an increased awareness of the possible medical and obstetric complications and an early recourse to abdominal delivery.
ABSTRACT
We determined the causal pathways of pregnancy-related deaths over a 16-year period. Pregnancy-induced hypertension was the chief contributor to our high maternal mortality rate of 36.9 per 100 000 births. Anaesthetic-related deaths were due to a combination of Mendelson's syndrome and faulty intubation technique. An improvement in the health-management system to identify high-risk mothers who need intensive emergency care and the availability of experienced personnel for obstetric anaesthesia appear to be indispensable requirements for reducing and minimising adverse maternal outcome in Trinidad.
