Determinants and outcome of Caesarean section in twin pregnancies in a tertiary hospital in Nigeria
AbstractBackground: Caesarean section has become commonplace in modern medical practice as it has become safer and more available, but the optimal mode of delivery for twins is undetermined and as remain controversial in the literature.
Aims: To determine the rate, indications and outcome Caesarean sections performed on twin pregnancies at the Niger delta University Teaching Hospital (NDUTH) Okolobiri, Bayelsa State.
Methods: The study is a four-year retrospective evaluation of all Caesarean sections performed on twin pregnancies at the Niger delta University Teaching Hospital Okolobiri, Bayelsa State.
Results: There were a total of 1341 deliveries and 41 cases of twin deliveries during the study period giving an incidence of 30.6/1,000 or 1 in 33 deliveries. The Caesarean section rate during the study period was 48.8%, 80.0% of which were performed as emergency procedures.
The three commonest indications in the series were breech presentation in twin one (30%) with (second twin cephalic), non cephalic leading twin (15%), eclampsia and severe pre-eclampsia (15%). Post operative complication rates were high (75.0%). Anaemia ranked highest 6(30.0%). The overall perinatal mortality in the study population was found to be 75.0/1000 birth. There were no maternal deaths.
Conclusion: Trial of vaginal birth after caesarean section in appropriate cases, the need to acquire skills in assisted vaginal breech delivery and use of cardiotocography for continuous fetal heart rate monitoring in labor with confirmation of suspected fetal distress through fetal blood acid-base study are recommended in order to reduce the high Caesarean Section rate in twin pregnancies.
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