O C Ezechi1, O B Fasubaa, B E K Kalu. 1. Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State Nigeria.
Abstract
BACKGROUND: Retained second twin contributes significantly to perinatal morbidity and mortality, as well as maternal morbidity and mortality, usually arising as a result of intervention to salvage the retained foetus. OBJECTIVE: To review the current incidence, management, fate and outcome of both the retained foetus and its mother, with a view to proffering solution. DESIGN: Retrospective review over a 12 year period from January 1988 to December 1999. SETTING: Obafemi Awolowo University teaching hospital, Ile Ife, Nigeria. SUBJECTS: All cases of retained second twin managed during this period. MAIN OUTCOME MEASURES: Causes, sources of referral, perinatal and maternal complications. RESULTS: The incidence is still high (7.9%). Majority of the patients were referred from rural centers (49.6%) and in poor fetal conditions (41.9%). The fetal survival in patients that presented within two hours of delivery of the first twin was 74.2%. The perinatal and maternal mortality were 47.3% and 3.9% respectively. CONCLUSION: The incidence and associated maternal and fetal complications of retained twin is still rather high. Therefore, irrespective of the antenatal course and early labour findings, the conduct of twin deliveries must be in a well-equipped health institution with adequate staff. There should also be an efficient referral system for occasional emergencies from the peripheral centres.
BACKGROUND: Retained second twin contributes significantly to perinatal morbidity and mortality, as well as maternal morbidity and mortality, usually arising as a result of intervention to salvage the retained foetus. OBJECTIVE: To review the current incidence, management, fate and outcome of both the retained foetus and its mother, with a view to proffering solution. DESIGN: Retrospective review over a 12 year period from January 1988 to December 1999. SETTING: Obafemi Awolowo University teaching hospital, Ile Ife, Nigeria. SUBJECTS: All cases of retained second twin managed during this period. MAIN OUTCOME MEASURES: Causes, sources of referral, perinatal and maternal complications. RESULTS: The incidence is still high (7.9%). Majority of the patients were referred from rural centers (49.6%) and in poor fetal conditions (41.9%). The fetal survival in patients that presented within two hours of delivery of the first twin was 74.2%. The perinatal and maternal mortality were 47.3% and 3.9% respectively. CONCLUSION: The incidence and associated maternal and fetal complications of retained twin is still rather high. Therefore, irrespective of the antenatal course and early labour findings, the conduct of twin deliveries must be in a well-equipped health institution with adequate staff. There should also be an efficient referral system for occasional emergencies from the peripheral centres.