The Management of Second Twin and its Perinatal Outcome in Comparison with First Twin

AIM: To study the management of second twin and its perinatal outcome in comparison with first twin in Modern Govt. Maternity Hospital. OBJECTIVES: The present study has been undertaken to study the influence of following factors on the perinatal outcome of second twin in comparison with first twin: Chorionicity, Gestational age. Presentation of twins, Mode of delivery, Birth weight, Birth interval. RESULTS: 150 twin pregnancies that were delivered in MGMH, Hyderabad were considered and the following analysis was done. There was one twin to twin transfusion syndrome, one cord entanglement which were included in the study. On analysis, the 150 twin cases the following results were obtained: In twin 1, 88.1% of DC and 67.5 %of MC had LBW, 1.8% of DC and 10% of MC had VLBW ; 10% of DC and 15% of MC had birth weight of >2.5 kg with p value of 0.39. It was statistically insignificant. In twin2, 84.5% of DC and 75% of MC had LBW, 3.6% of DC and 25% of MC had VLBW and 11.8% of DC and 10% of MC had birth weight >2.5 kg. It was statistically insignificant. CONCLUSION: The perinatal outcome of the second twin was poor when compared to the first twin. Poor perinatal outcome in terms of low apgar score at 5 minutes, NICU admissions, neonatal deaths were more in second twin. This may be due to increased prematurity, low birth weight, birth asphyxia and mal presentations in twins. More complications are expected for the second twin compared to the first. Strict intrapartum monitoring, availability of expert obstetrician to conduct delivery along with good neonatal intensive care facilities are crucial in improving the perinatal outcome.