Intra-partum management of twin deliveries- A three year retrospective audit.
Abstract Number: 49
Abstract Type: Other
Introduction: The incidence of twin deliveries has increased in the recent past, predominantly due to the improvement in assisted reproductive therapies.1 Vaginal twin delivery at term is associated with foetal and maternal morbidity and mortality. Despite an increased rate of anaesthetic intervention and the risk of emergency abdominal delivery of the second twin, there is no consensus on the anaesthetic management of twin deliveries.2 Current practice in our unit is to advice early epidural for women with multiple gestations, however no guideline exists for optimal utilisation of the epidural for emergency obstetric interventions arising during the twin delivery. The aim of our audit was to evaluate intra-partum management and outcomes of these high risk pregnancies.
Methodology: After the local audit committee approval retrospective, observational case note review of 83 women with twin pregnancy between 2007-2009 in a teaching hospital was done. Intra-partum management of these pregnancies including type of analgesia/anaesthesia for labour and delivery, the mode of delivery and neonatal outcomes with their APGAR scores were reviewed.
Results: Out of 83 women, 12 women had elective caesarean section for various reasons most common being non-vertex presentation of the first twin. 60 women underwent trial of vaginal delivery. 54 (96%) women received epidural analgesia for labour of which 8 epidurals were topped up to provide anaesthesia for emergency section. Out of three women who needed emergency caesarean for the second twin, 2 women had epidural top-up at the beginning of second stage while one woman needed G.A.
Discussion: Despite lack of guidelines for intrapartum epidural management we topped-up majority of epidurals in early second stage for, in-utero manipulation and delivery of the second twin. Only one woman with epidural in situ did not receive a top-up in time to be converted to anaesthesia. However we recommend in addition to early epidural placement, having local guidelines for management of epidurals in second stage will improve the safety profile of the twin deliveries.
1. Tsen L C.The more the merrier: should anesthesologists be present for multiple births? Int J Obstet Anesth 2008; 17: 205-7.
2. Carvalho B, Saxena A, Butwick A, Macario A. Vaginal twin delivery: a survey and review of location, anesthesia coverage and interventions. Int J Obst Anesth 2008; 17: 212-6.