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Antenatal and intra-partum management of twins – a DGH experience
  1. B Mylrea Lowndes1,2,
  2. M Pureti1
  1. 1Stepping Hill Hospital, Stockport, UK
  2. 2Manchester University School of Medicine, Manchester, UK

Abstract

Aim To examine antenatal and intra-partum management of twin pregnancies, review the available guidelines and compare the current practice in our unit with recommendations.

Methods 3 year retrospective audit from 1 April 2007 to 31 March 2010. The data was collected by proforma and anonymised for patient confidentiality.

Results There were 174 twin pregnancies, out of which 39 (22%) were monochorionic and 135 (78%) dichorionic (figure 1). There was one monochorionic monoamniotic pregnancy. Chorionicity was recorded in all but one case1 and usually confirmed between 11 and 14 weeks. 27% of monochorionic and 6.7% of dichorionic twins had fewer scans than recommended.

Abstract PFM.66 Figure 1
Abstract PFM.66 Figure 1

There was inadequate documentation of consultation regarding mode of delivery.2

12.1% of second twins were delivered by emergency caesarean after vaginal delivery of twin 1, and the caesarean rate for vertex/vertex presentation was 44.1% and 52.3% for vertex/non-vertex. Of these 65 caesareans, 10 were done for maternal request (15.4%).

39 first twins (22.4%) and 52 second twins (29.9%) were admitted to NICU. The mortality was 1.4% for dichorionic and 15.3% for monochorionic.

Conclusion/recommendations This audit highlighted the need for better counselling regarding mode of delivery, especially when twin 1 is vertex, as 15.4% of these women had elective caesarean for maternal request. 12.1% of second twins were delivered by caesarean.

The audit also brought to light the need for local guidelines, patient information leaflets and a dedicated team for the management of twins. All these issues have been addressed since the audit. We aim to re-audit in a year to assess change in practice.

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