Breech births in twin pregnancy: an analysis of Apgar score and perinatal mortality from a Nigerian sample

Abstract

Perinatal mortality (PNM) rates are reported for 146 twin-1 and 192 twin-2 breech births among 622 consecutive twin pairs delivered at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Stillbirths and infants with severe asphyxia (Apgar score 1-3) were recorded in significant proportions of both first and second twin breech infants. PNM rates were 13.7% twin-1, 18.8% twin-2; corrected PNM for infants weighing 2.0 kg or more, were 9.3% and 12.4% for twin-1 and twin-2, respectively. Twin specific breech PNM decreased with increasing birthweight of first and second twin to a low optimum in the weight group 2.5-2.9 kg, and thereafter rose for both first and second twin with birthweight 3.0 kg and above. Factors such as low birthweight, breech/breech presentation, breech extraction and retained second twin breech contributed significantly to the high PNM rates. More favorable PNM rates were recorded among a limited number of breech infants delivered by primary cesarean section for breech/breech or first twin breech presentations. A liberal approach to cesarean section delivery for breech twin births, and particularly for paired breech/breech presentations is strongly advocated.

PIP: Perinatal mortality (PNM) rates are reported for 146 twin-1 and 192 twin-2 breech births among 622 consecutive twin pairs delivered at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Stillbirths and infants with severe asphyxia (Apgar score 1-3) were recorded in significant proportions of both 1st and 2nd twin breech infants. PNM rates were 13.7% twin-1, 18.8% twin-2; corrected PNM for infants weighing 2.0 kg or more, were 9.3% and 12.4% for twin-1 and twin-2, respectively. Twin specific breech PNM decreased with increasing birthweight of 1st and 2nd twin to a low optimum in the weight group 2.5-2.9 kg, and thereafter rose for both 1st and 2nd twin with birthweight 3.0 kg and above. Factors such as low birthweight, breech/breech presentation, breech extraction, and retained 2nd twin breech contributed significantly to the high PNM rates. More favorable PNM rates were recorded among a limited number of breech infants delivered by primary cesarean section for breech/breech or 1st twin breech presentations. A liberal approach to cesarean section delivery for breech twin births, and particularly for paired breech/breech presentation is strongly advocated. Cesarian section increases maternal and fetal risks, and the risks are further aggravated by anesthesia. While for the mother, the risks are related to increased cardiovascular stress and aorto-caval compression, for the fetus, low birthweight and asphyxia are real problems. Despite these known risks, there have been reports of favorable maternal and perinatal results for cesarian section in twin pregnancy. For optimum results, caution must, however, be exercised to deliver such infants in well-equiped hospitals with skilled personnel in attendance.