Outcomes of dichorionic twin pregnancies in a South African setting

Swart, H. A. (2015-12)

Thesis (MMed)--Stellenbosch University, 2015.

Thesis

ENGLISH ABSTRACT: Objective The 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 South Africa (middle-income country). Method This retrospective observational study included all DC twin pregnancies seen in the Obstetric Ultrasound Unit between 1 January and 31 December 2011. Primary aims were to review the mode and gestational age at delivery. Secondary aims included a composite of maternal and perinatal outcomes. Results 266 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) and mean birth weight was 2233g (±602g). In 156 of the 213 (73,2%) pregnancies reaching 28 weeks, 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 maternal disease (33,3%) and abnormal fetal lie (29.8%). Hypertensive diseases of pregnancy were the most common maternal complication affecting 70 women (30,3%) and preterm labour or preterm prelabour rupture of membranes were the most common antenatal complication affecting 103 pregnancies (45,4%). Neither the composite maternal adverse outcome (p=0,30) nor the composite early neonatal adverse outcome (p=0,61) was significantly different between the women who experienced labour and the prelabour caesarean delivery group. Conclusion DC twin pregnancies were delivered at an earlier gestation and had a higher caesarean rate than reported in other developing countries. Similar to the available literature there was a higher incidence of antenatal maternal and fetal complications compared to singletons. Long intertwin delivery times and a higher rate of combined deliveries were observed in the study population. This could possibly be prevented in limited resource countries with more liberal use of epidural analgesia and active management of the delivery of the second twin during vaginal delivery.

AFRIKAANSE OPSOMMING: Doelwit Die doelwit van hierdie studie was om die perinatale hantering en uitkomste van dichorioniese (DC) tweeling swangerskappe in Tygerberg Hospitaal, ‘n sekondêre en tersiêre verwysings hospitaal in Suid-Afrika (middel inkomste land) te evalueer. Metodes Hierdie retrospektiewe observasie studie was uitgevoer in TBH en het al die DC tweelingswangerskappe ingelsuit wat in die Obstetriese Sonar Eenheid gesien is tussen 1 Januarie en 31 Desember 2011. Die primêre doelwitte was om die metode en swangerskapsduur van verlossing te beskryf. Die sekondêre doelwitte het ‘n samestelling van moederlike en perinatale uitkomste ingesluit. Resultate 266 DC tweelinge is geëvalueer gedurende hierdie periode en verlossings uitkomste is ingesamel by 227 (85.3%). Die mediane gestasie by verlossing was 35 weke 1 dae (±4 weke 2 dae) en gemene geboorte gewig was 2233g (±602g). In 156 van die 213 (73,2%) swangerskappe wat 28 weke gestasie bereik het, is daar prober vir vaginale verlossing. Dit het gelei tot 82 (52,6%) vaginale verlossings, 65 (41,7%) nood keisersnitte en 9 (5,8%) gekombineerde verlossings. ’n Keisersnit is voor die aanvang van kraam uitgevoer in 57 van die 213 (26,8%) gevalle. Dit was hoofsaaklik aangedui vir moederlike siekte (33,3%) en abnormale fetale ligging (24,6%). Hipertensiewe siektes van swangerskap was die mees algemene moederlike komplikasie en het 70 vroue (30,3%) geaffekteer. Voortydse kraam of voortydse ruptuur van vliese was die mees algemente antenatale komplikasie wat 103 swangerskappe (45,4%) geaffekteer het. Nog die saamgestelde moederlike uitkomste (p=0,30), nog die saamgestelde neonatale uitkomste (p=0,61) was noemenswaardig verskillend tussen die groep vroue wat kraam ervaar het en die groep met ‘n keisersnit voor die aanvang van kraam nie. Gevolgtrekking DC tweelingswangerskappe is by ‘n vroeër gestasie verlos en het meer keisersnitte gehad as wat gerapporteer word in ander ontwikkelende lande. Soorgelyk aan beskikbare literatuur was daar ‘n hoër insidensie van antenatale moederlike en fetale komplikasies in vergeleke met enkelswangerskappe. ‘n Lang tydperk tussen die verlossings van die twee babas en ‘n hoër aantal gekombineerde verlossings is gevind wat moontlik voorkom kan word deur die meer algemene gebruik van epidurale analgesie en aktiewe hantering van die verlossing van die tweede baba tydens vaginale verlossing in lande met beperkte beskikbare bronne.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/98047
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