Second twin outcome at birth: retrospective analysis in a single tertiary centre in Malaysia

Rahana Abd Rahman; Azmawati Mohammed Nawi; Shareena Ishak; Kartik Balaraman; Mohamad Azrai Abu; Siti Hajar Abd Azman; Aida Hani Kalok; Nor Azlin Mohamed Ismail; Zaleha Abdullah Mahdy; Shuhaila Ahmad

doi:10.1515/jpm-2023-0449

Second twin outcome at birth: retrospective analysis in a single tertiary centre in Malaysia

J Perinat Med. 2024 Mar 22;52(4):385-391. doi: 10.1515/jpm-2023-0449. Print 2024 May 27.

Authors

Rahana Abd Rahman^{1

2}, Azmawati Mohammed Nawi^{2

3}, Shareena Ishak^{2

4}, Kartik Balaraman^{1

2}, Mohamad Azrai Abu^{1

2}, Siti Hajar Abd Azman^{1

2}, Aida Hani Kalok^{1

2}, Nor Azlin Mohamed Ismail^{1

2}, Zaleha Abdullah Mahdy^{1

2}, Shuhaila Ahmad^{1

2}

Affiliations

¹ Department of Obstetrics & Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia.
² Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia.
³ Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia.
⁴ Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia.

PMID: 38511669
DOI: 10.1515/jpm-2023-0449

Abstract

Objectives: To investigate factors associated with outcome of second twin during labour.

Methods: The study was a retrospective cohort study in a single tertiary centre in Malaysia from 2014 until 2018 involving all twin pregnancies delivered at or more than 24 weeks of gestation.

Results: Total of 409 twin pregnancies were included. Dichorionic twin comprises of 54.5 % (n=223) and 45.5 % (n=186) are monochorionic. Women with dichorionic pregnancies are significantly older (p<0.001), have more pre-existing medical disorders (p=0.011) and fetal structural anomalies (p=0.009). Monochorionic pregnancies are significantly more amongst Malay (p=0.01) and conceived spontaneously (p<0.001). There are significantly more fetuses both in cephalic presentation (p=0.026), birthweight discrepancy more than 20 % (p=0.038) and shorter mean inter-twin delivery duration (p=0.048) in monochorionic pregnancies. Second twin delivered with Apgar score <7 is significantly more in dichorionic pregnancies (p=0.006). The second twin is associated with lower birthweight, small for gestational age and arterial cord pH<7.25. Within the group of women who delivered both fetuses vaginally, there was significantly more second twins with intertwin delivery duration less than 30 min who were delivered vaginally without instrumentation (p=0.018). There was significantly more second twin with intertwin delivery duration of 30 min and more with arterial cord pH<7.25 (p=0.045). Those who delivered spontaneously had inter-twin delivery duration within 15-29 min. The outcome of second twin is not influenced by type of twin, gestational age at delivery, inter-twin delivery duration, mode of delivery and presentation at birth.

Conclusions: The neonatal outcome for the second twin at birth is not influenced by type of twin, gestational age at delivery, inter-twin delivery duration, mode of delivery and presentation at birth in a cohort managed with non-active management of the second twin in Malaysia.

Keywords: chorionicity; labour; neonatal outcome; retrospective cohort; twin.

MeSH terms

Adult
Birth Weight
Female
Humans
Infant, Newborn
Malaysia / epidemiology
Pregnancy
Pregnancy Outcome* / epidemiology
Pregnancy, Twin* / statistics & numerical data
Retrospective Studies
Tertiary Care Centers / statistics & numerical data
Twins, Dizygotic