Twin delivery after a caesarean section -- always a section?
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Adult↗
Biomedical subjects
J K Essel
Publications and source records attributed to J K Essel.
Is routine caesarean section necessary for breech-breech and breech-transverse twin gestations?
OBJECTIVE: To determine if perinatal outcome is affected by the route of delivery in breech-breech and breech-transverse twin gestations. DESIGN: Prospective observational study. SETTING: Umtata General Hospital, a referral hospital for approximately 32 rural hospitals throughout the former transkei. SUBJECTS: Twin gestations with breech-breech and breech-transverse presentations. MAIN OUTCOME MEASURES: Birth weights, 5-minute Apgar scores and neonatal mortality rates among 41 women who underwent vaginal delivery were compared with those of 27 who underwent transverse lower-segment caesarean sections. RESULTS: A total of 68 women were involved in the study. Forty-one were delivered vaginally and 27 underwent transverse lower-segment caesarean sections. The vaginal delivery group consisted of 35 breech-breech and 6 breech-transverse twin gestations, while the caesarean section group comprised 25 breech-breech and 2 breech-transverse presentations. Both twin I and twin II in the caesarean section group were bigger than their respective counterparts delivered vaginally (P < 0.02 for twin I and P < 0.01 for twin II). There were no statistically significant differences in either 5-minute Apgar scores or neonatal mortality rates between the two groups. CONCLUSION: Vaginal delivery of breech-breech and breech-transverse twin gestations appears a reasonable option provided criteria for vaginal breech delivery are adhered to.
Apgar Score↗
Macrosomia--maternal and fetal risk factors.
Risk factors associated with fetal macrosomia were studied in 348 pregnancies resulting in the delivery of an infant weighing 4,000 g or more in a black population. Identifiable maternal risk factors included a mother in her 3rd decade of life, multiparity, maternal weight of 70 kg or more at the end of pregnancy, prolonged or post-term pregnancy, abnormal glucose tolerance and previous history of a macrosomic infant. Male infants had a higher risk of being macrosomic. Macrosomic infants accounted for 3.4% of all singleton deliveries, with their caesarean section rate of 33.9% being almost three times that of control infants. The importance of antenatal prediction of fetal weight is emphasised and suggestions for reduction of the high perinatal mortality and morbidity rates, as well as maternal morbidity, are discussed.
Adult↗
Twin birth-weight discordancy in Transkei.
A study of twin birth-weight discordancy revealed a high incidence of 11.7% (1 in 9 deliveries) among 478 pairs of twins delivered. The second twin had a lower birth weight and a poorer perinatal outcome, as does the smaller twin irrespective of birth order. Major birth-weight discrepancies were found in dichorionic twins. In twins of unlike sex, males were heavier, irrespective of birth order, which suggests that fetal gender may be an important aetiological factor. It is suggested that growth retardation of one of a pair of twins, rather than twin transfusion syndrome, is a more important contributor to birth-weight discordancy.
Birth Weight↗