Sahel Medical Journal (Jan 2011)
Fetal outcome of labour with retained second twin in a tertiary health institution in Sokoto, North-Western Nigeria
Abstract
Background: After the delivery of the leading twin, the second twin is at risk of distress from decreased placental perfusion due to premature separation of the placenta, birth trauma from intrauterine manipulations and increase in operative intervention due to mal-presentations. Aim: To evaluate the fetal outcome in cases of retained second twin in tertiary health institution in Sokoto, North-Westem Nigeria. Method: The case notes of patients who were managed for retained second twin at the Usmanu Dan-fodiyo University Teaching Hospital (UDUTH), Sokoto, from January 2005 to December 2009 were retrieved and analysed. The chi-square table was used to analyse some of the results. Results: During the study period, there were 163 twin births out of 10,221 total deliveries, giving a twining incidence of 16 per 1000 births. There were 33 cases where the second twin was retained, representing 3.2 per 1000 births or 1 in 5 twin deliveries. The peri-natal mortality of the second twin (515.2 per 1000 births) was significantly higher than the 151.5 per 1000 births observed for the first twin (p<0.01). The fetal case fatality rate in patients who presented 4hours after delivery of the first twin(61.5%) was significantly higher than that (14.3%) noted in those who presented within 4 hours of delivery (p<0.05). Mal-presentation and uterine atony accounted for (48.2%) and (39.4%) causes of retained twin respectively. Maternal morbidity was encountered in 60.6% of cases, and the commonest maternal complications were postpartum haemorrhage and uterine rupture. Conclusion: Twin pregnancy and delivery require care in institutions with facilities for intervention. Early referral of retained second twin to well-equipped hospitals is associated with better fetal outcome.
