Nabeela Shami, Naghmana Akbar, Shaheena Asif.
An analysis of Fetal and Maternal Morbidity and Mortality in Retained Second Twin.
J Coll Physicians Surg Pak Jan ;11(12):750-3.

Objective : To evaluate the maternal morbidity, fetal morbidity and mortality related to retained second twin. Design : A prospective study. Place and Duration of Study: Jinnah Hospital, Lahore from July 1996 to March 1998. Materials and Methods: Patients presenting to the labor ward after having delivered the first twin at home and with retention of the second twin in utero were included in the study. A total number of 7 patients were included in this study. Result : Malpresentation was seen in 3 patients (42.83%) and uterine inertia in 2 (28.57%) were found to be the commonest reasons for causing retention of second twin, while uterine inertia and malpresentation together was seen in 1 patient (14.28%) and cephalopelvic disproportion in 1 patient (14.28%). The perinatal mortality rate was 71.42%. Maternal morbidity like fever was seen in 4 patients (57.14%), while postpartum hemorrhage was seen in two patients (28.75%). Blood transfusion was required in 5 patients (71.42%). Complications like scar dehiscence was also seen. In postpartum period breast engorgement requiring treatment with bromocriptine was seen in 3 patients (42.83%). Conclusion: Retained second twin is associated with a high perinatal mortality rate and also causes increased morbidity in mother. Thus, patients with twin gestation should be referred earlier to a center equipped to handle such a high risk pregnancy and its associated problems at birth; and the problem of retained second twin should not be allowed to develop in a teaching hospital.

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