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.
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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