Outcomes of dichorionic twin pregnancies in a South African setting

[摘要] ENGLISH ABSTRACT: ObjectiveThe aim of this study was to evaluate the perinatal management and outcomes of dichorionic(DC) twin pregnancies in Tygerberg Hospital, a secondary and tertiary referral centre in SouthAfrica (middle-income country).MethodThis retrospective observational study included all DC twin pregnancies seen in the ObstetricUltrasound Unit between 1 January and 31 December 2011. Primary aims were to review themode and gestational age at delivery. Secondary aims included a composite of maternal andperinatal outcomes.Results266 DC twins were assessed during this period and delivery outcomes were obtained in 227(85,3%). The mean gestational age at delivery was 35 weeks 1 day (±4 weeks 2 days) andmean birth weight was 2233g (±602g). In 156 of the 213 (73,2%) pregnancies reaching 28weeks, vaginal delivery was attempted. This resulted in 82 (52,6%) vaginal, 65 (41,7%)emergency caesarean and 9 (5,8%) combined deliveries. In 57 of the 213 (26,8%)pregnancies, a prelabour caesarean delivery was required. This was mainly due to maternaldisease (33,3%) and abnormal fetal lie (29.8%).Hypertensive diseases of pregnancy were the most common maternal complication affecting70 women (30,3%) and preterm labour or preterm prelabour rupture of membranes were themost common antenatal complication affecting 103 pregnancies (45,4%). Neither thecomposite maternal adverse outcome (p=0,30) nor the composite early neonatal adverseoutcome (p=0,61) was significantly different between the women who experienced labour andthe prelabour caesarean delivery group.ConclusionDC twin pregnancies were delivered at an earlier gestation and had a higher caesarean ratethan reported in other developing countries. Similar to the available literature there was ahigher incidence of antenatal maternal and fetal complications compared to singletons. Longintertwin delivery times and a higher rate of combined deliveries were observed in the studypopulation. This could possibly be prevented in limited resource countries with more liberaluse of epidural analgesia and active management of the delivery of the second twin duringvaginal delivery.

[发布机构] Stellenbosch University