Objectives

1. Obstervational study of Perinatal and Maternal Outcome of Planned Twin Deliveries in Hospital Sultanah Aminah, Johor Bahru Quek Y.S. (1), Woon S.Y. (1), Ravichandan N. (2), Kaliammah MK (1), Shantala V. (3), Ravichandran J. (1) 1. Hospital Sultanah Aminah Johor Bahru, Malaysia 2. Singapore General Hospital 3. Kokilaben Dhuribhai Ambani Hospital, India (Visiting MFM Consultant) OPTIONALLOGO HERE OPTIONALLOGO HERE Objectives Results Results Conclusions There is general consensus that vaginal delivery for twin is safe when both twin are in vertex presentation, whereas planned caesarean section is typically indicated for breech presentation of the first twin1. In fact, studies on the effect of presentation, mode of delivery and birth order have produced conflicting results. The only randomized study of mode of delivery in twin pregnancy was performed towards the end of 1980s and demonstrated that there was little difference in neonatal morbidity between twins delivered vaginally and those delivered by caesarean section1. The objective of this study is to compare the perinatal and maternal outcome with different planned mode of delivery for twin pregnancies. Nineteen cases of planned vaginal delivery group had emergency caesarean with fetal distress being the commonest indication. Among those with successful vaginal delivery, instrumental delivery was required in 2 occasions for 1st twin only, 2 occasions for 2nd twin only, 2 occasions for both twins. There were no significant differences in obstetric outcomes in both groups (Table 2). Overall, there were no significant differences in the perinatal outcomes (umbilical arterial blood parameters) between twin siblings who were scheduled for planned vaginal delivery versus planned caesarean (Table 3). All infants have 5-minute Apgar score >8. Total 71 sets of twins had planned vaginal delivery whereas 42 sets had planned caesarean delivery (Figure 1). Both groups are similar for maternal demographic characteristics (Table 1). Twin pregnancy is a high risk pregnancy associated with increased maternal morbidity and increase perinatal morbidity and mortality. There is a need for specialised prenatal care to reduce complications and adverse outcome in multiple pregnancies, and the need for ongoing social and medical care beyond the prenatal and perinatal periods2. In our hospital, twins delivered vaginally had comparable maternal and perinatal outcomes compared to twins delivered via caesarean. With appropriate patient selection, antenatal care, intra-partum fetal surveillance, good co-operation with neonatal team and patient counselling, planned vaginal delivery still remains a safe mode of delivery. Table 1. Demographic characteristics in different planned mode of delivery Table 3. Neonatal Outcomes in different planned mode of delivery Methods This is a prospective observational study which included 113 sets of twins delivered at ≥ 36 weeks from January to December 2009. Monochorionic monoamniotic (MCMA) twins were excluded. The primary outcome was a measure of perinatal and maternal outcome in different planned mode of delivery. The groups were compared for differences in maternal characteristics and perinatal outcomes by using Student t test, chi square analysis or Fisher exact test when appropriate. The level of significance was set at p value < 0.05. Data presented as mean ± SD or n (%). Table 2. Obstetric Outcomes of different planned mode of delivery References 1. Rossi AC, Mullin PM, Chmaitb RH. Neonatal outcomes of twins according to birth order, presentation and mode of delivery: a systematic review and meta-analysis. BJOG 2011; 118:523-532 2. Herbst A, Ka¨lle´n K. Influence of mode of delivery on neonatal mortality in the second twin, at and before term. BJOG 2008;115:1512–1517. Results Data presented as mean ± SD or n (%). *Non-significance **constant data Generally, all mothers were happy and entire cohort preferred singleton with vaginal delivery in next pregnancy (Table 4). Table 4. Psychological aspects in different planned mode of deliver Data presented as mean ± SD or n (%). *Non-applicable Data presented as n (%).