[Active management of the second twin for vaginal delivery: ruptured versus intact membranes. Apropos a series of 182 patients]

Accouchement gémellaire en milieu africain: une analyse de 10 ans dans le District de Bamako au Mali

Introduction Aim

It was to determine the factors influencing the prognosis of the second twin's delivery.

Methods

The study was retrospective and covered all cases of twin births registered at our maternity from 1^stJanuary 2007 to 31^st December 2016 (10 years).

Results

We recorded 34,899 deliveries among which 1374 twin deliveries (2.54%). Almost 15% were primiparous; 39.16% were referred; 69.10% and 15.5% without prenatal care. The factors negatively influencing prognosis for second twin were: a delay>15 minutes between twin deliveries, delayed caesarean section, non-qualification of the midwife, monochoreal, low birth weight. Otherwise parity and obstetric maneuvers had no influence on the prognosis 2^nd twin.

Conclusion

The prognosis of 2^nd twinisstronglyinfluenced by a birth delay> 15 minutes, the other factors acting as cofactors.

[Training achieves an internal version and a total breech extraction at birth of second twin]

OBJECTIVES

To evaluate French residents in obstetrics and gynaecology's training to internal version and breech extraction during vaginal delivery of the second twin.

METHODS

A national descriptive survey conducted among 1064 residents between July and October 2014. Respondents were invited by email to specify the type of theoretical and practical training they had received, their university hospital obstetrical practices and the number of vaginal internal version and breech extraction of the second twin they had seen and performed.

RESULTS

Response rate was 38.7% (n=412). Regarding the type of theoretical training, 39.8% of residents (n=164) had received the obstetrical mechanics and techniques degree; 47.6% (n=196) had got a teaching during special education classes and 29.4% (n=121) a training on mannequin. There were important differences between regions. At the end of residency, 45.6% of residents (n=36) had practiced more than five vaginal internal version and breech extraction of the second twin.

CONCLUSION

Internal version and breech extraction are difficult but essential maneuvers for the management of twin delivery. The French residents in obstetrics and gynaecology's training for these maneuvers seems to be insufficient. It is necessary to improve their teaching, this teaching must also be equivalent between regions.