Browsing by Author "Swart, H. A."

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    Outcomes of dichorionic twin pregnancies in a South African setting
    (Stellenbosch : Stellenbosch University, 2015-12) Swart, H. A.; Van der Merwe, J. L.; Geerts, P.; Muller, C.; Stellenbosch University. Faculty of medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.
    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.