Perinatal and maternal mortality associated with retained second twins

Abstract

Objectives: The aim of this study of retained second twins admitted to Korle-Bu Hospital between 1988 and 1993 was to identify the factors contributing to the mode of delivery, perinatal and maternal mortalities, and draw up recommendations to improve outcome. Methods: The study consisted of a review of record cards, outpatient admission and discharge books, delivery books, and inpatient case notes of women admitted with retained second twins of 28 weeks' or more gestation during the study period. Results: Of the 65 cases fully reviewed, 33 (approximately 50%) were delivered by cesarean section due mainly to abnormal lie with or without shoulder impaction. The rest were assisted deliveries, mainly vertex deliveries or breech extractions. The perinatal mortality of the retained second twins was 38.5% compared with 12.3% for the first twins. Although in general the longer the interdelivery interval, the greater the second twin perinatal mortality risk, no clear direct correlation could be established. There was one perioperative maternal mortality due to anaphylactic reaction to intramuscular morphine injection. Conclusion: Irrespective of the antenatal course and early labor findings, twin delivery should be undertaken in a unit equipped for cesarean section and assisted delivery. The unacceptably high perinatal mortality of retained second twins could thus be significantly reduced.