TEMPLATE DESIGN © 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) ObjectivesResultsConclusions References Results OPTIONAL LOGO HERE Methods This is a prospective observational study which included 113 sets of twins delivered at ≥ 36 weeks from January to December 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 < Results 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). Data presented as mean ± SD or n (%). 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: 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. Data presented as n (%). Planned Vaginal Delivery (n = 71) Planned Caesarean Delivery (n = 42) Psychological Well-being Happy65 (91.5)40 (95.2) Unhappy6 (8.5)2 (4.8) Preferred type of pregnancy Singleton61 (85.9)36 (85.7) Twin10 (14.1)6 (14.3) Preferred mode of delivery Vaginal delivery59 (83.1)30 (71.4) Caesarean delivery12 (16.9)12 (28.6) Table 4. Psychological aspects in different planned mode of deliver Data presented as mean ± SD or n (%). *Non-significance**constant data Characteristics Planned Vaginal Delivery (n = 71) Planned Caesarean Delivery (n = 42) 1 st twin2 nd twin p- value 1 st twin2 nd twin p- value Birth weight (kg) 2.42 ± ± 0.34 NS* 2.46 ± ± 0.51 NS* Apgar Score9.0 ** 8.91 ± 0.17 NS*9.0 ** 8.98 ± 0.15 NS* Umbilical Arterial Blood pH 7.34 ± ± NS* 7.33 ± ± NS* Base Excess (BE) ± ± 4.85 NS* ± ± 2.82 NS* Admission to neonatal ward 18 (25.4) NS*18 (42.9)20 (47.6)NS* Mean length of ward stay (days) 2.5 ** NS*1.17 ** NS* Table 3. Neonatal Outcomes in different planned mode of delivery Data presented as mean ± SD or n (%).*Non-applicable Characteristics Planned Vaginal Delivery (n = 71) Planned Caesarean Delivery (n = 42) 1 st Twin2 nd Twin1 st Twin2 nd Twin Gestational Age of Delivery (weeks)37.31 ± ± 0.86 Final mode of delivery Vaginal Delivery52 (73.2)NA* Emergency Caesarean Delivery19 (26.8)18 (42.9) Elective Caesarean DeliveryNA*24 (57.1) In successful Vaginal Delivery Spontaneous Vertex Delivery48 (92.3)22 (42.3)NA* Vacuum assisted delivery3 (5.8)5 (9.6)NA* Forceps assisted delivery1 (1.9) NA* Assisted Breech deliveryNA*24 (46.2)NA* Estimated Blood Loss ± ± Post-partum haemorrhage8 (11.3)6 (14.3) Blood Transfusion required3 (4.2)3 (7.1) Table 2. Obstetric Outcomes of different planned mode of delivery Characteristics Planned Vaginal Delivery (n = 71) Planned Caesarean Delivery (n = 42) P-value Maternal Age29.03 ± ± Ethnic Groups0.062 Malay50 (70.4)18 (42.9) Chinese13 (18.3)13 (31.0) Indian5 (7.0)5 (11.9) Others3 (4.2)6 (14.3) Weight (kg)62.12 ± ± Height (metre)1.58 ± ± BMI (kg/m 2 )24.75 ± ± Type of Chorionicity0.151 Monochorionic Diamniotic42 (59.2)19 (45.2) Dichorionic Diamniotic29 (40.8)23 (54.8) Table 1. Demographic characteristics in different planned mode of delivery 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 section 1. 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 1 st twin only, 2 occasions for 2 nd 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. Generally, all mothers were happy and entire cohort preferred singleton with vaginal delivery in next pregnancy (Table 4). 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 periods 2. 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.