Perinatal outcome of non vertex second twin after vaginal delivery of first twin at Saint Paul’s hospital millennium medical college, Addis Ababa, Ethiopia: Retrospective Cohort study

Abstract

<p><strong>Background:</strong> Considering Presentation of the second twin in determining the route of delivery for vertex first twin remains an area of controversy. This study aimed to determine whether presentation of the second twin following vaginal delivery of a vertex first twin affects neonatal outcomes at SPHMMC, Addis Ababa, Ethiopia from January 2016 to January 2020&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</p> <p><strong>Methods</strong>: Hospital based, Retrospective cohort study design was conducted based on data collected from 429 mothers using a structured data extraction form. 143 women with non vertex second twin were compared with 286 women with vertex second twin that fulfils the inclusion criteria. The ratio of exposed to none exposed was taken as 1: 2. Data was collected by trained residents. Data was entered and analyzed using SPSS version 21. Relationship among the major variable were described by chi-square test (P&lt;0.05). &nbsp;In order to measure the association between an exposure and an outcome relative risk (RR, with 95% CI) was calculated. Logistic regression model (adjusted for perinatal confounders and mode of delivery) were developed to determine odds of adverse outcomes associated with presentation. The perinatal mortality rate was calculated by using S-Statistical soft ware for both exposed and non exposed group and association was checked using chi-square test (P&lt;0.05). <em>P-value</em>&lt;0.05 was considered statistically significant. &nbsp;</p> <strong>Result</strong>: A total of 429 twin pregnancies were included, 33.3% of these had a non-vertex second twin. Caesarean section was more common in non-vertex presentations (11.2% vs 2.1%, <strong>p &lt; 0.001</strong>). The odds of Apgar score &lt; 7 at 5^thminutes (14% vs 5.6%, OR 2.7444,95%CI 1.375-5.477), still birth (4.2% vs 0.7%, AOR 5.482,95%CI 1.073-27.995) Apgar &lt; 7 at 1^st minutes(47.6% vs 23.1%, AOR 2.782,95%CI 1.784-4.338), NICU admission (29.4% vs 27.3%, OR 1.109,95%CI 1.109-1.729) and early neonatal death (18.9% vs 9.1%, AOR 2.355,95% CI 1.331-4.168) were significantly higher among non vertex second twin. &nbsp; <br> <br><strong>Conclusion</strong>: Perinatal mortality rate and Neonatal morbidities such as low 5^th minute APGAR score were found to be higher among non vertex second twin after vaginal delivery of the first twin. Vaginal delivery of twin with the non vertex second twin is not a reasonable management option although skill of resident in attending non vertex presentation and gestational age specific outcome is not seen.