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Twin Deliveries (twin + delivery)

Distribution by Scientific Domains
Medical Sciences75%

Selected Abstracts

Twin deliveries and place of birth in NSW 2001,2005

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2009
Charles S. ALGERT
Background:, Twin pregnancies have an elevated risk of adverse outcomes, particularly preterm twins. Aims:, Describe the distribution of twin deliveries by hospital level, the associated perinatal and maternal morbidity, and determine predictors of perinatal morbidity and urgent transfer to a neonatal intensive care unit. Methods:, Longitudinally linked New South Wales delivery and hospital records for the years 2001,2005 were used to identify perinatal and maternal morbidity/mortality in twin pregnancies. Regression analysis was used to examine predictive factors, including birth hospital volume. Results:, At , 32 weeks, 88.1% of twins were delivered in tertiary referral hospitals. By 34,35 weeks, only 39.7% of twins were delivered in tertiary units. Gestational age was the primary predictor of perinatal morbidity/mortality. Perinatal morbidity/mortality and maternal morbidity were lowest for deliveries at 38 weeks. There was no evidence that planned caesarean section at , 38 weeks was protective against perinatal morbidity/mortality. There was an increased risk of perinatal morbidity/mortality (odds ratio (OR) = 2.22) for twins delivered at 33,35 weeks gestation at hospitals with < 500 deliveries per annum, and an increased risk of urgent neonatal transfer (OR = 2.06). Twin pairs for whom there was a , 20% discordance in birthweight had an increased risk of morbidity/mortality at 36,38 weeks (OR = 1.79). Conclusions:, Both infant and maternal morbidity increase from 39 weeks gestation. Delivery of twins before 36 weeks at smaller hospitals (< 500 deliveries per annum) should be avoided. A twin pregnancy where there is a , 20% difference in estimated fetal weights should be considered for referral to a tertiary obstetric unit. [source]

The changing association between prenatal participation in WIC and birth outcomes in New York City

JOURNAL OF POLICY ANALYSIS AND MANAGEMENT, Issue 4 2005
Ted Joyce
We analyze the relationship between prenatal WIC participation and birth outcomes in New York City from 1988,2001. The analysis is unique for several reasons. First, we have over 800,000 births to women on Medicaid, the largest sample ever used to analyze prenatal participation in WIC. Second, we focus on measures of fetal growth distinct from preterm birth, since there is little clinical support for a link between nutritional supplementation and premature delivery. Third, we restrict the primary analysis to women on Medicaid who have no previous live births and who initiate prenatal care within the first four months of pregnancy. Our goal is to lessen heterogeneity between WIC and non-WIC participants by limiting the sample to highly motivated women who have no experience with WIC from a previous pregnancy. Fourth, we analyze a large sub-sample of twin deliveries. Multifetal pregnancies increase the risk of anemia and fetal growth retardation and thus may benefit more than singletons from nutritional supplementation. We find no relationship between prenatal WIC participation and measures of fetal growth among singletons. We find a modest pattern of association between WIC and fetal growth among U.S.-born Black twins. Our findings suggest that prenatal participation in WIC has had a minimal effect on adverse birth outcomes in New York City. © 2005 by the Association for Public Policy Analysis and Management [source]

Twin deliveries and place of birth in NSW 2001,2005

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2009
Charles S. ALGERT
Background:, Twin pregnancies have an elevated risk of adverse outcomes, particularly preterm twins. Aims:, Describe the distribution of twin deliveries by hospital level, the associated perinatal and maternal morbidity, and determine predictors of perinatal morbidity and urgent transfer to a neonatal intensive care unit. Methods:, Longitudinally linked New South Wales delivery and hospital records for the years 2001,2005 were used to identify perinatal and maternal morbidity/mortality in twin pregnancies. Regression analysis was used to examine predictive factors, including birth hospital volume. Results:, At , 32 weeks, 88.1% of twins were delivered in tertiary referral hospitals. By 34,35 weeks, only 39.7% of twins were delivered in tertiary units. Gestational age was the primary predictor of perinatal morbidity/mortality. Perinatal morbidity/mortality and maternal morbidity were lowest for deliveries at 38 weeks. There was no evidence that planned caesarean section at , 38 weeks was protective against perinatal morbidity/mortality. There was an increased risk of perinatal morbidity/mortality (odds ratio (OR) = 2.22) for twins delivered at 33,35 weeks gestation at hospitals with < 500 deliveries per annum, and an increased risk of urgent neonatal transfer (OR = 2.06). Twin pairs for whom there was a , 20% discordance in birthweight had an increased risk of morbidity/mortality at 36,38 weeks (OR = 1.79). Conclusions:, Both infant and maternal morbidity increase from 39 weeks gestation. Delivery of twins before 36 weeks at smaller hospitals (< 500 deliveries per annum) should be avoided. A twin pregnancy where there is a , 20% difference in estimated fetal weights should be considered for referral to a tertiary obstetric unit. [source]

Deterioration in cord blood gas status during the second stage of labour is more rapid in the second twin than in the first twin

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2004
Tak-Yeung Leung
Objective To compare in twin pregnancy the rate of deterioration in umbilical blood gas status during the second stage of labour, and to investigate whether the duration of the first twin's delivery has any effect on the blood gas status of the second twin. Design A retrospective study. Setting Department of Obstetrics and Gynaecology in a university teaching hospital. Population Twin pregnancies with both of the twins delivered by normal cephalic vaginal mode, at or beyond 34 weeks of gestation, over a period of seven years. Twins with any maternal or fetal complications including discordant growth, intrauterine growth restriction, intrauterine death, fetal malformations, fetal distress, pre-eclampsia and diabetes were excluded. Methods The first twins' second stage was defined as from the start of maternal pushing to his/her delivery, while the second twins' second stage started after the delivery of the first twin and ended by his/her delivery. The total duration of the second stage was the sum of the above two intervals. The correlations between the first twins' umbilical cord blood gas parameters and the duration of their own second stage, the second twins' umbilical cord blood gas parameters and the duration of their own second stage, as well as that of the total second stage, were studied. Main outcome measures The changes of umbilical arterial pH of each twin with the duration of the corresponding second stage of labour, and the difference among them. Results A total of 51 cases were reviewed. The median gestation at delivery was 37 weeks. The median duration of first twins' second stage was 10 minutes (range 1,75) while that of the second twins' was 10 minutes (range 3,26). The first twins' second stage was inversely correlated with their arterial pH, venous pH and base excess [BE] (P < 0.01). Both the second twins' second stage and the total second stage were inversely correlated with both of their arterial and venous pH and BE (P < 0.01). However, further multiple regression analysis suggested that the correlation of the total second stage with the second twins' cord blood parameters could be solely explained by their own second stage. The rate of reduction in the second twins' arterial pH was 4.95 × 10,3 per minute, and was significantly faster than that of the first twins', which was 1.55 × 10,3 per minute (P < 0.05). Conclusions During normal vaginal delivery, the umbilical cord blood gas status of both the first and the second twins deteriorated with the duration of their corresponding second stages, but the effects are greater in the latter. Furthermore, the duration of the first twins' second stage does not affect the blood gas status of the second twins'. These observations support the postulation of a diminished uteroplacental exchange function after the delivery of the first twin. Close monitoring and expeditious delivery of the second twins are important. [source]