Twin Deliveries Research Articles

Trial of labor of vertex-nonvertex twins following a previous cesarean delivery

Maternal and neonatal outcomes of trial of labor after cesarean delivery of twins are similar to those of singleton trials of labor after cesarean delivery. However, previous studies did not stratify outcomes by second-twin presentation on admission to labor. To examine maternal and neonatal outcomes following trial of labor after cesarean delivery in twins with vertex-nonvertex presentation. A retrospective multicenter study was conducted including data on deliveries occurring between the years 2005 and 2020. We included trials of labor after a previous cesarean delivery (at ≥320/7 weeks' gestation) of twin gestations with a vertex-presenting first twin on admission to labor. The exposed group was defined as deliveries with a nonvertex second twin at admission to labor, whereas the comparison group included deliveries with a vertex second twin at admission. Only parturients who attempted vaginal delivery were included. Cases of prelabor fetal death of either twin or major fetal anomalies were excluded. The primary outcome was uterine rupture. A total of 236 twin trials of labor after cesarean delivery were included, of which 128 involved nonvertex second twins and 108 a second vertex twin. Uterine rupture rates were comparable between the groups (1/128 [0.9%] vs 1/108 [0.8%]; P=1.000). Successful trial of labor after cesarean delivery of both twins occurred in 76.6% of the exposed group vs 81.5% of the comparison group, whereas cesarean delivery of both twins was performed in 21.9% of the exposed group vs 17.6% of the comparison group (P=.418; odds ratio, 1.32; confidence interval, 0.7-2.5). Two cases of cesarean delivery of the second twin occurred in the exposed group and 1 in the comparison group (1.6% vs 0.9%, respectively, P=1.000). There was no difference between the groups in maternal outcomes, including rates of postpartum hemorrhage, blood transfusion, placental abruption, thromboembolic events, and maternal fever. Neonatal outcomes were also comparable between the groups, including rates of intensive care admission and low (≤7) 5-minute Apgar scores. Our data show thattrial of labor after cesarean delivery of noncephalic second twins holds favorable maternal and neonatal outcomes, comparable with those of vertex-vertex trials of labor after cesarean delivery.Second-twin noncephalic presentation should not discourage parturients and caregivers from considering trial of labor after cesarean delivery if desired.

Induction of labor in twin pregnancies – A retrospective cohort study

ObjectiveTo investigate outcomes in spontaneous and induced twin deliveries. Secondary aims were to study impact of delivery interval and breech presentation of the first twin. MethodsThis retrospective cohort study comprised 354 twin deliveries at a tertiary Norwegian hospital. Spontaneous labor onset and induction of labor were compared in women with planned vaginal delivery and gestational age ≥ 34 weeks. The main outcome was intrapartum cesarean section. Secondary outcomes were umbilical arterial pH and five-minute Apgar scores. ResultsAmong the induced labors, 63/229 (27.5%) women underwent intrapartum cesarean section, compared to 45/125 (36%) in spontaneous labors (P = 0.10). Odds ratio for intrapartum cesarean section in induced labors was 0.65 (95% CI 0.40–1.04) after adjusting for maternal age and parity.Median umbilical arterial pH was significantly lower in the second twins in both spontaneous and induced labors, 7.28 (6.94–7.43) vs. 7.32 (7.16–7.42), and 7.27 (6.90–7.48) vs. 7.29 (7.08–7.45), respectively. pH < 7.00 rarely occurred. Second twins born after a delivery interval > 30 min had a significantly higher frequency of pH < 7.10 than those with a shorter interval, P < 0.01. No significant difference was found in frequency of pH < 7.10 between breech-presenting and cephalic-presenting first twins (P = 0.65). One unexpected intrapartum fetal death occurred after labor induction. ConclusionOur results support spontaneous onset and induction of labor as safe. Intrapartum cesarean section rates did not differ significantly between spontaneous and induced labors. Delivery interval > 30 min was associated with a lower pH in the second twin.

Risk factors for twin pregnancy in women undergoing double cleavage embryo transfer

BackgroundTwo or more embryo transfers have been used to increase the success rate of live birth in traditional in vitro fertilization (IVF) strategy at the expense of increased risks of multiple pregnancy and adverse perinatal outcomes. The decision regarding the elective single embryo transfer or double embryo transfer remains inconclusive. The aim of this study was to investigate the risk factors for twin pregnancy in IVF.MethodsParticipants who underwent their first fresh IVF cycle where two cleavage stage embryos were transferred in Women’s Hospital of Zhejiang University between January 2010 and December 2018 were included in this retrospective cohort study. The primary outcome was twin delivery. Secondary outcomes included preterm birth and low birth weightResultsFifteen thousand four hundred fifty-nine women were available for final analysis, in which 1511 women resulted in twin delivery and 4788 women had singleton delivery. Female age over 35 was associated with reduced rates of twin pregnancy compared with female age at or less than 35 (9.5% vs 25.1%, aRR = 0.38 (0.27. 0.55)). Poor-type endometrium was associated with reduced rates of twin pregnancy (19.2% vs 27.5%, aRR = 0.75 (0.58. 0.96)). Two good-quality embryos for transfer was associated with significantly higher rates of twin pregnancy compared with one good-quality or none good-quality embryo (26% vs 12.8% vs 9.3%, aRR = 0.56 (0.45. 0.70), aRR = 0.44(0.26. 0.74)). Female age over 35 and none or one good-quality embryo for transfer were associated with reduced rate of low birth weight and preterm birth.ConclusionWomen with age over 35, poor-type endometrium, one good-quality embryo or none good-quality embryo were associated with reduced rate for twin pregnancy.

Facteurs de risque de césarienne sur deuxième jumeau après accouchement voie basse du premier jumeau : étude cas-témoins

ObjectivesTo identify risk factors for cesarean section of the second twin after vaginal delivery of the first twin. MethodsCase-control study conducted between 2004 and 2018 in a tertiary center, CHU Toulouse. Cases were women with twin pregnancy who had vaginal delivery of the first twin and emergency cesarean of the second twin. Controls were women with twin pregnancy who delivered both twins vaginally. Deliveries before 24 weeks of gestation, birth weight of less than 500 grams, fetal death in utero, terminations of pregnancy and delayed delivery were excluded. The association between potential risk factors and cesarean delivery of the second twin was analyzed using multivariable logistic regression. ResultsTwenty-four patients who had vaginal delivery of the first twin and emergency cesarean of the second twin and 48 patients who delivered both twins vaginally were included. Neonatal morbidity was increased in the group of women who had an emergency cesarean of the second twin. In multivariable analysis, overweight (OR=10.5 [95% CI: 1.78–62.03] for women with body mass index above 25 compared to women with body mass index below 25), weight gain during pregnancy (OR=1.27 [95% CI: 1.01–1.48] for each kilogram) and preterm labor (OR=4,43 [IC 95%:1,10–17,80]) were associated with significantly increased risk of cesarean section of the second twin. ConclusionOverweight and weight gain during pregnancy are associated with increased risk for cesarean section of the second twin.

Maternal fetal outcome in multiple versus singleton pregnancies delivered in a teaching hospital

To compare the maternal and fetal outcome in multiple versus singleton pregnancies in a private teaching hospital in India. Prospectively collected data on 50 twin deliveries from July 2018 to November 2021 were studied to determine its incidence; the maternal and foetal outcome, and compared with 50 singleton deliveries conducted on same day following the twin delivery who served as controls, the twins were also analysed on the basis of chorionicity. A total of 3415 deliveries were conducted during the study period, of which 50 were twin deliveries, giving an incidence of 14 per 1000 births or 1.4:100 deliveries. Six among 50 twins resulted following ovulation induction. Women with twin gestation had a mean maternal age of 24.7±3.71, same for the singleton mothers was 24.26±3.7years; mean gestational age at delivery for twins and singletons were 35.38±2.6 and 38.63±1.19 weeks; mean birth weight for twins and singletons were 2.193kgs and 2.85±0.46kgs, mean parity were 2.04± 1.0 and 1.72±0.7 respectively. Parity, gestational age, NICU stay characteristics showed p value &amp;#60; 0.05. Compared with singletons, women with twin gestations had a positive risk association with odds &amp;#62;1 for anaemia, preeclampsia, preterm labour, malpresentation and caesarean delivery. Twin Neonates suffered prematurity, low birth weight, congenital anomaly, prolonged NICU care and increased perinatal death. Neonatal risk was more among monochorionic twins than dichorionic twins. There were 3 cases with single fetal demise, and both fetuses IUD in another case, (total IUDs-5), one twin was still born, two had early neonatal death and there were two late neonatal (&amp;#62;7 Days) deaths. One twin mother threw fits on the 6th postpartum day. Another mother received 20 units of blood and component replacement and subtotal hysterectomy for PPH. Despite improvement in antenatal and neonatal care, twins pose a higher threat to MCH outcome. Hence, thorough counselling, patient awareness, more vigilance at interpretation of antenatal tests, intrapartum monitoring and bridging the gap between demand and supply at NICU facility can improve maternal and neonatal outcome; as well as can help parents cope with the psychological stress.

Clinical data analysis of nine years of experience with twin pregnancy: a tertiary hospital-based retrospective study

Background: The incidence of twin pregnancy has been increasing worldwide and in China. This study provided a comprehensive analysis of the clinical data of twins in a Chinese tertiary hospital and summarized the clinical characteristics. Methods: A retrospective collection of data was carried out for 717 cases of twins in the Obstetrics Department of the First Affiliated Hospital of Xi’an Jiaotong University from 2011 to 2020. A comprehensive analysis of baseline information and maternal and perinatal outcomes was conducted, and the twin birth rate of the study population was also calculated. Results: The average twin delivery rate was 2.61%. A total of 206 cases were monochorionic, and 511 cases were dichorionic. Premature delivery, hypertensive disorder complicating pregnancy and premature rupture of membranes were the three most common complications. Caesarean section rates from 2011 to 2019 were maintained at 70%–80%. A total of 144 cases (20.08%) of 717 twin cases were complicated twins. Birthweight discordance ≥25% accounted for 13.53% of cases. Adverse neonatal outcomes with higher incidences were neonatal respiratory distress syndrome, small for gestational age and 1 min Apgar score ≤7. Conclusions: Twin pregnancy has different and unique clinical features. Obstetricians should pay close attention to its clinical management to obtain better perinatal outcomes.

Successful delayed delivery of the second twin by evacuating the cord prolapsed first fetus and emergent cerclage: a report of 2 cases

BackgroundIn twin pregnancies, the cord prolapse of either fetus during the pre-viable period leads to fetal death but can also cause an intrauterine infection, leading to death or prematu-re birth of the remaining fetus. However, there are no validated protocols to prolong the gestational period or decrease the morbidity and mortality of the remaining fetus.Case presentationThe present cases were PPROM and cord prolapse very early during the second trimester (around 17 weeks in the first case and 19 weeks in the second case). The first fetus was evacuated, and cervical cerclage was performed at 23 and 20 weeks in the two cases, respectively. After maintaining the pregnancy, the second baby was born around 27 and 39 weeks in the first and second cases, respectively. The delivery interval between the first and second fetuses was 46 days in the first case and 126 days in the second case.ConclusionIf cord prolapse is identified at a pre-viable time in twin fetuses, evacuation and cerclage should be performed as soon as possible after the cord prolapse to reduce intrauterine infection and increase the survival chances of the remaining fetus.

Mode of delivery, perinatal outcome and neurodevelopment in uncomplicated monochorionic diamniotic twins: a single-center retrospective cohort study

BackgroundThere is no agreement on the effect of planned mode of delivery in the perinatal morbidity and neurodevelopment in uncomplicated monochorionic diamniotic as well as regarding the safest mode of delivery. In this paper we have aimed to analyze the impact of the mode of delivery in uncomplicated monochorionic diamniotic twins ≥ 32 weeks of gestation.Material and methodsThis study included 72 women, followed and attended at our department, with uncomplicated monochorionic diamniotic pregnancies who had a birth between 32.0 and 37.6 weeks of gestation from January 2012 to December 2018. Outcomes were recorded in women who underwent planned vaginal delivery (induced or spontaneous onset of labor), and women who underwent a planned cesarean section for any reason that excluded vaginal delivery. Primary outcomes included: (1) A composite of any of the following: neonatal death, 5-min Apgar score < 4, respiratory distress syndrome, bronchopulmonary dysplasia, sepsis, periventricular leukomalacia, intraventricular hemorrhage, and necrotizing enterocolitis. (2) Neurodevelopmental status at 2 years of corrected age.ResultsIn this period, 42 women (58.3%) had a planned vaginal delivery, and 30 women (41.7%) had a planned cesarean section. In the first group, 64.3% had a vaginal delivery. The rate of successful vaginal delivery was similar regardless the onset of labor. We did not find a higher composite perinatal morbidity in the planned vaginal delivery group (planned vaginal delivery: 3.6% vs. planned cesarean section: 8.3%, aOR 1.36, 95% CI 0.24–7.81). Considering the onset of labor, it was more frequent in the spontaneous subgroup (8.3% vs. 0%). The rate of neurodevelopmental impairment was higher in the planned cesarean section group, without reaching statistical significance [10.2% vs. 4.9%, aOR 1.53 (95% CI 0.37–6.29)].ConclusionsIn uncomplicated monochorionic diamniotic twins at ≥ 32 weeks of gestation, when the first twin is in vertex presentation, our results suggest that planned vaginal delivery is safe, with a successful outcome as well as high vaginal delivery rate.

Study on Maternal and Neonatal Outcome of Women Undergoing Caesarean Section using NICE Classification in a Tertiary Care Hospital in Rural Area of Central India - An Observational Prospective Study

Background :Caesarean section is often perceived to be safer than vaginal delivery for mothers and neonates, and thus has become increasingly common around the globe. However, it may actually be detrimental to maternal and neonatal health while consuming valuable resources.Objective :The objective of this study was to categorize the caesarean sections performed in our rural institute into various categories using NICE classification and to study the maternal and neonatal outcome in them.Method :This was a prospective study of all women who underwent caesarean section over a period of 18 months. Data was retrieved from the files of women for morbiditiy and mortality in mothers and babies. Data was entered in MS excel sheet and analyzed with percentages and chi square test using SPSS ver.17.Results:Caesarean section rate (CSR) was 36.88%. All CS were classified into four categories based on urgency as per NICE guidelines. There were 22.62% women in Category I, 38.61% in category II, 28.37% in category III and 10.40% in Category IV. Adhesions, extension of angle, lacerations in lower segment, scar dehiscence, atonic PPH and bladder injury were noted in (12.83%), 11.81%, 6.83%, 4.08% , 1.53% and 0.08% CS respectively. Caesarean hysterectomy was done in 0.24% cases. Postoperative morbidity was febrile morbidity (11.93%), postdural puncture headache (13.85%), paralytic ileus (11.49%), wound infection (8.83%), ARDS (0.70%), sepsis (0.78%), pulmonary edema (0.47%) and pulmonary embolism (0.03%). Maternal mortality was 0.03%. Neonates born were 2577 (29 were twin deliveries). 82.46% neonates were healthy, 16.80% had morbidities and 0.74% were still born. Apgar score of less than 7 was in 10%. 16.80% neonates were admitted in NICU during their hospital stay. Neonatal mortality was 1.47%.Conclusion :Intraoperative and post-operative complication were more in caesarean sections of category I and II as compared to category III and category IV. Neonatal morbidity, mortality and admissions to NICU were more in caesarean sections of category I and II as compared to category III and category IV. Thus though caesarean section is an emergency lifesaving procedure for mother and baby it may prove detrimental to their health.

Trial of labor after cesarean in twin gestation with no prior vaginal delivery - evidence from largest cohort reported.

ObjectiveTo investigate trial of labor after cesarean (TOLAC) success rates in twin gestations with no prior vaginal delivery.MethodsA retrospective study of women with twin gestations who underwent a TOLAC and had no prior vaginal delivery during 2011–2020. TOLAC success and failure groups were compared.ResultsOf 675 twin gestations with a history of cesarean delivery and no prior vaginal delivery, 83 (12.3%) elected to undergo a TOLAC and 26 (31.3%) succeeded. Two (7.7%) women delivered by cesarean for the second twin after vaginal delivery of the first twin. Epidural analgesia was positively associated with TOLAC success (odds ratio [OR] 4.31, 95% confidence interval [CI] 1.56–11.94, P = 0.004). Uterine rupture occurred in two patients (3.5%) of the TOLAC failure group. The proportion of cases with low Apgar score (<7) at 5 min was higher in the TOLAC success group (4 [15.4%] versus 1 [1.8%]; OR 10.1, 95% CI 1.07–96.22, P = 0.032) and the neonatal composite adverse outcome rate was lower in this group (OR 0.22, 95% CI 0.07–0.69, P = 0.009).ConclusionTOLAC in women with twins with no prior vaginal delivery is associated with a low success rate. No independent predictors of successful TOLAC were identified.

Survival Without Severe Neonatal Morbidity in Very Preterm Twins According to Planned Mode of Delivery.

To assess survival to discharge without severe neonatal morbidity by planned mode of delivery for twins born before 32 weeks of gestation. The JUMODA (JUmeaux MODe d'Accouchement) study was a French national prospective, population-based, cohort study of twin deliveries conducted from February 2014 to March 2015. This planned secondary analysis included diamniotic twin pregnancies from 26 0/7 through 31 6/7 weeks of gestation. Exclusion criteria included contraindications to vaginal delivery and situations for which planned cesarean delivery is favored, and neonatal prognosis depends largely on the underlying pathology rather than the planned mode of delivery. The primary outcome was survival to discharge without severe neonatal morbidity (bronchopulmonary dysplasia, grade 3 or grade 4 intraventricular hemorrhage, periventricular leukomalacia, stage 2 or stage 3 necrotizing enterocolitis). The association between planned mode of delivery and primary outcome was assessed by multivariate Poisson regression model. A propensity-score approach with inverse probability of treatment weighting also was performed to control for indication bias. Subgroup analyses according to birth order and sensitivity analyses limited to spontaneous preterm births only were performed. Among 424 very preterm twin pregnancies, 192 (45.3%) had a planned cesarean delivery and 232 (54.7%) had a planned vaginal delivery. Survival to discharge without severe morbidity did not differ in the two groups: 308 of 384 (80.2%) after planned cesarean and 375 of 464 (80.8%) after planned vaginal delivery (crude relative risk 0.99; 95% CI 0.91-1.15; adjusted relative risk 1.02; 95% CI 0.93-1.11). After applying inverse probability of treatment weighting, planned cesarean delivery still was not associated with higher survival to discharge without severe neonatal morbidity than planned vaginal birth (relative risk 1.11; 95% CI 0.84-1.46). Subgroup and sensitivity analyses showed similar results. Planned cesarean delivery for very preterm twins is not associated with higher survival to discharge without severe neonatal morbidity than planned vaginal delivery. These results suggest that very preterm delivery should not be considered a per se indication for planned cesarean in twin pregnancies.

Outcomes of Twin Delivery at the Bamenda Health District, North West Region Cameroon

Introduction: Multiple gestations or multiple pregnancies occur when two or more fetuses are conceived at the same time in the same woman. Therefore, a twin pregnancy is defined as the simultaneous development of two fetuses in the same woman. It can either be a monozygotic or dizygotic pregnancy. Twin pregnancy is considered a high-risk pregnancy with variable incidence and outcomes worldwide. The adverse maternal and fetal outcomes of twin deliveries have not yet been investigated in our setting. Objectives: The main objective of this study was to evaluate the outcomes of twin deliveries at the Bamenda Health District. Methods: This was a hospital-based, cross-sectional analytic study done at the Bamenda Health District in three selected hospitals (Bamenda Regional Hospital, CMA Nkwen, and IHC Azire) from the 1st of January to the 10th of May 2018. 55 women with twin pregnancies and 55 women with singleton pregnancies at gestational ages of 28 completed weeks and above who came for delivery and who consented to the study were included. A face-to-face interview-administered questionnaire was used to obtain sociodemographic characteristics; a venous blood sample was collected from the mothers before and after delivery to determine the estimated blood loss based on haemoglobin level. The partogram was opened from 4 cm cervical dilatation for those who came in the first stage of labour and the mode of delivery was recorded. After delivery, outcome variables were 1st, 5th, and 10th min Apgar score, birth weight, and gestational age. Data were entered in CSPro 7.1 and exported to IBM SPSS version 23.0 for analysis. All variables with p Results: During the study period, we included 110 participants (55 twin mothers and 55 singleton mothers). Women with twin gestations were mostly aged between 25 and 34 years with a mean maternal age of 28.6 ± 5.8 years, more than half (60%) of them were multiparous with family histories of twin, and business was their main occupation (58.2%). The prevalence of twin gestations at the Bamenda Health District was 2.8%. As compared to singleton deliveries, twin deliveries were associated with adverse fetal outcomes such as prematurity (born before 37 completed weeks) which was about 6 times higher among twins than singleton babies (OR: 5.6, 95% CI: 2.2 - 14.3, p th min) that was 15 times higher in twin than singleton births (OR: 15.3, 95% CI: 2 - 116.6, p grams) that was 15.6 times increased in twin than singleton births (OR: 15.6, 95% CI: 3.6 - 67.8, p CI: 2.2 - 13.9, p 0.05). Conclusion: Twin deliveries were associated with adverse fetal outcomes (prematurity, birth asphyxia, and low birth weight) in the three health facilities where we carried out the study. Cesarean section was higher among women with twin gestations compared to women with singleton gestations.

Clinical Characteristics and Pregnancy-Related Outcomes of Pregnant Women Hospitalized with COVID-19 During the Delta Wave: A Single-Center Observational Study.

BackgroundCoronavirus disease 2019 (COVID-19) during pregnancy is associated with increased disease severity and an increased risk of perinatal complications. However, few studies of pregnant women with COVID-19 have been conducted in Korea. The purpose of this study was to describe the clinical course and pregnancy outcomes of pregnant women admitted to our hospital with COVID-19 according to the severity.Materials and MethodsThis retrospective cohort study included women aged 18 years of age or older who were hospitalized in the Gachon University Gil Medical Center with COVID-19 during pregnancy between July 1, 2021 and January 31, 2022. COVID-19 severity was classified according to the “Criteria for severity classification by symptoms of COVID-19” presented by the Korea Disease Control and Prevention Agency. Severe cases were defined as those who required oxygen treatment administered via a high-flow nasal cannula or invasive mechanical ventilation or should be applied extracorporeal membrane oxygenation (ECMO) or continuous renal replacement therapy.ResultsA total of 103 pregnant women were hospitalized with COVID-19 during the study period. Their mean age was 33 (± 4.14) years, and 4 (3.9%) had been vaccinated against COVID-19. At the time of diagnosis of COVID-19, 3 (2.9%), 33 (32.0%), and 67 (65.1%) patients were in the first, second, and third trimester, respectively. The most common symptoms were cough (99 patients, 96.1%) and fever (85 patients, 82.5%). There was 1 (1.0%) asymptomatic patient. Forty patients (38.8%) required supplemental oxygen and 19 patients (18.4%) had severe disease. Of the 19 severe cases, 7 were in the 2nd trimester and 12 were in the 3rd trimester. Forty-one (39.8%) patients delivered, including two twin deliveries. Of the 41 cases of delivery, 14 were premature, 4 out of 21 (19.0%) in mild, 4 out of 12 (25.0%) in moderate, and 6 out of 8 (75.0%) in severe. Severe disease was associated with an increased rate of preterm birth (P = 0.012). Four of the 43 neonates (9.1%) received oxygen treatment.ConclusionPregnant women with COVID-19 had a high rate of severe disease and a high preterm delivery rate, especially among those with severe disease.

Vaginal Delivery of the Second Twin: A Simulation Program for Residents in Obstetrics and Gynecology in a Type III University Maternity Hospital

Vaginal Delivery of the Second Twin: A Simulation Program for Residents in Obstetrics and Gynecology in a Type III University Maternity Hospital

Sonography Cervical Assessment in Twin Pregnancy Correlation with Gestational Age at Delivery

Objective: Observe and correlate the funneling of upper cervical canal by ultrasound and likelihood of cervical incompetence and premature delivery in twin pregnancy. Materials and methods: Retrospective study in twin pregnancies deliveries in 1997, in king Faisal specialist hospital and research center, Riyadh, Saudi Arabia. A total of 67 twin pregnancies underwent routine ultrasound for fetal assessment, when the cervix closed, long; and short, funneling. The time of ultrasound was divided in three groups by gestational age: from 18 to 22 weeks; from 22 to 26 weeks and from 26 to 30 weeks. The gestational age at delivery was our outcome parameter and subdivided the patients in 4 groups, group 1: patients delivered before 24 weeks (n = 4); group 2: delivered between 24 and 34 weeks (n = 16); group 3: delivered between 34 weeks and 36 weeks and 6 days (n = 18); and group 4: delivered with gestational age equal or above 37 weeks (n = 29). The data was analyzed statistically using Pearson chi square method and p value below 0.05 was considered significant. Results: There was no significant difference among the 4 subgroups in maternal age, body mass index, parity, previous history of preterm delivery or presence of urinary/vaginal infection in actual pregnancy. There was stronger history of mid trimester abortion in patients delivered before 34 weeks of gestational age. Considering the cervical sonographic findings, the diagnosis of funneling between 18 - 22 weeks was higher among the group delivered before 34 weeks of gestational age (1 and 2) comparing to other groups (3 and 4) with p value equal to 0.016. The finding in ultrasound justifies the results of higher aggressive management in patients from groups 1 and 2 comparing with groups 3 and 4; admission to hospital (p = 0.007); emergency cerclage (p = 0.04), complete hospital bed rest (p = 0.002). Conclusion: Cervical assessment during routine ultrasound in twins pregnancy seems to be useful for prediction of preterm delivery and counseling the patient without risk factors regarding cervical cerclage. Because of restricted number of patients, especially group 1 (11 = 4), we suggest further study with bigger sample and prospective trial for valued conclusion.

Abstract- Poster

Introduction:Agenesis of Corpus callosum (ACC) is a rare disorder that presents at birth (congenital), it is characterized by partial or complete absence of an area of the brain that connects two cerebral hemispheres. It is linked with psychiatric disorders, cognitive deficits, learning disabilities and developmental delays.Case 1:A 13-year-old male was brought to OPD with c/o aggressive behaviour, school refusal and epilepsy of one week duration. History revealed delayed milestones, MRI showing partial ACC. He was treated with olanzapine and sodium valproate with significant improvement in aggression.Case 2:A 22-year-old male was brought to OPD with c/o irritability, decreased sleep, delayed milestones, epilepsy with left sided hemiparesis in the last 3 weeks. Was treated with phenytoin and valproate for epilepsy. Birth history revealed pre-term twin delivery with birth asphyxia. He was treated with risperidone with significant improvement in behavioural abnormalities.Conclusion:Early diagnosis and treatment of behavioural abnormalities and epilepsy can improve the outcome and improve quality of life.

Total breech extraction of the second twin in trial of labor after cesarean

Maternal and neonatl outcomes in trial of labor after cesarean (TOLAC) deliveries of twins are similar to singleton TOLACs. We examined whether internal podalic version and total breech extraction of the second twin adversely impacts outcome. A retrospective multicenter study was conducted including data on deliveries occurring between 2005-2020. We included TOLACs only, at 320/7 gestational weeks and on, of twin gestations with a vertex presenting first twin upon labor admission. The exposed group was defined as deliveries with a non-vertex second twin at admission to labor, while the comparison group included deliveries with a vertex second twin at admission. Only parturients who attempted vaginal delivery were included. Cases of pre-labor fetal death of either twin or major fetal anomalies were excluded. The primary outcome was uterine rupture. Two hundred thirty-six twin TOLACs were included, of whom 128 presented with a non-vertex second twin, and 108 presented with a second vertex twin. There was no difference in the primary outcome of uterine rupture (1/128, 0.9% vs. 1/108, 0.8%, p=1.000) (Table 1). Successful TOLAC of both twins occurred in 76.6% of the exposed group vs. 81.5% in the comparison group, while cesarean delivery (CD) of both twins was performed in 21.9% of the exposed group vs. 17.6% of the comparison group (p=0.418, OR=1.32, CI 0.7-2.5). There were 2 cases of CD for the second twin in the exposed group and one case in the comparison group (1.6% vs. 0.9%, respectively, p=1.000) (Table 2). There was no difference between the groups in maternal outcomes, including rates of postpartum hemorrhage, blood transfusion, placental abruption, etc. (Table 1). Neonatal outcomes were also comparable between the groups. Non-cephalic second twin in TOLAC deliveries results in favorable maternal and neonatal outcomes, comparable with vertex-vertex TOLACs. Second twin non-cephalic presentation should not discourage parturients and caregivers from considering TOLAC if desired.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Maternal parity and obstetric outcomes among twin deliveries

Maternal parity and obstetric outcomes among twin deliveries

Delivery of second breech twin.Comparison between vaginal delivery of vertex and breech second twins

Delivery of second breech twin.Comparison between vaginal delivery of vertex and breech second twins

Prevalence and Factors Associated With Caesarean Delivery in Nepal: Evidence From a Nationally Representative Sample.

BackgroundCaesarian sections (CS) are life-saving management for a pregnant mother and fetus subject to obstetric complications. The World Health Organization (WHO) expected CS rates not to exceed 10 to 15 per 100 live births in any country. This study aimed to assess the prevalence of CS and its associated factors from the 2016 Nepal Demographic and Health Survey (NDHS), building on previous studies mentioned in detail in the latter part of the paper.MethodsThis study analyzed the secondary data from the 2016 Nepal Demographic and Health Survey (NDHS), conducted from June 19, 2016, to January 31, 2017. The survey is undertaken every five years; consequently, the data capture the information in the previous five years from the data collection period. We used the 2016 NDHS, which is implemented by the new Enumeration Area (EA) under the support of the Ministry of Health (MOH) and funded by the U.S. Agency for International Development (USAID). In the rural areas, the sample is stratified and selected in two stages. In the first stage, wards are selected as the primary sampling units (PSU), with households subsequently chosen from the PSUs. In the urban areas, the sample is nominated in three stages. In the first stage, wards are selected as PSUs; in the second stage, one EA is chosen from each PSU, and finally, households are selected from the EAs. Then data were collected from the women in the reproductive age group within the selected households.ResultsThe prevalence of CS in Nepal conforms to the WHO standard with 7.8, 7.5, and 8.1 per 100 deliveries, or 9.8, 8.9, and 9.1 per women’s last births in the previous one, three, and five years, respectively. Older mothers of 30 years old or more, having high incomes, being overweight and obese, using the internet, ante-natal care (ANC) visits of more than four times, ANC by doctors, twin delivery, and having babies of 4 kg or more, had higher odds for a CS while having two or more children seemed to be protective towards CS.ConclusionThese findings can be used to update health policies surrounding CS delivery to limit unnecessary CS and ensure better health as CS is not without complications.