Having read both the articles supplied, comment on the second one. I know the OB people have to gain skills for emergencies but it is pretty pathetic to subject mothers and babies to the trauma and anxiety of these obstetric interventions "just for practice". Another example of women and babies not being respected by the medical establishment in that hospital. Cheers Judy
--- leanne wynne <[EMAIL PROTECTED]> wrote: > I have copied two articles which may be of some help to you. > All the best, > Leanne. > > Investigating the inter-twin interval > Issue 11: 30 May 2005 > Source: American Journal of Obstetrics and Gynecology 2005; > 192: 1420-2 > > > The length of time between the birth of the first and second > twin has no > significant effect on the immediate neonatal outcome of the > younger twin, > according to the results of a new study. > > > Specialists in maternal-fetal medicine at the Saint Joseph > Mercy Hospital in > Ypsilanti, Michigan, USA, reviewed the hospital’s medical > records concerning > the neonatal outcomes of all live-born viable vaginal twin > deliveries over a > 6-year period: a total of 144 sets of twins. > > They used statistical analyses to identify factors > significantly associated > with immediate neonatal outcomes of the second twin: the > umbilical arterial > pH, the umbilical venous pH, the 1-minute Apgar score and the > 5-minute Apgar > score. > > Overall, the inter-twin time interval for the twins studied > ranged from a > few minutes to an extreme of about 130 minutes. > > The 1- and 5-minute Apgar scores were significantly predicted > only by > gestational age and birth weight, while umbilical arterial and > venous pH > were significantly predicted only by the inter-twin interval. > For every > extra minute of the inter-twin interval, the arterial pH fell > linearly by > 0.00063 units, and the venous pH by 0.00081 units. > > Second twins born more than 45 minutes after the first twin > typically had an > arterial or venous pH that was 0.07 units lower than that of > second twins > born within 15 minutes of the first twin. > > Not clinically relevant? > The researchers say their study confirms that a longer > inter-twin interval > is associated with a “continuous slow decline” in umbilical > cord pH. But > they add: “However, although these pH differences may be of > note from a > physiologic standpoint, we do not believe that they are of a > magnitude great > enough to influence clinical management.” > > They continue: “We believe our data support the view that > expectant > management of the second twin birth is appropriate and do not > support > arbitrary intervention based solely on time.” > > > The second-twin delivery dilemma > Issue 08: 22 Apr 2002 > Source: > > European Journal of Obstetrics & Gynecology and Reproductive > Biology 2002; > In press (lead author Pons J-C) > > The first twin has been delivered successfully, but what is > the optimal > method for delivering the second? The two main options are > active and > expectant management, a choice that has been the subject of > debate among > specialists for many years. That debate is now furthered by a > new study > comparing the two approaches. > > Specialists in Grenoble and Paris, France, carried out a > retrospective study > investigating twin births at two maternity units over a 2-3 > year period: a > total of 78 pairs of twins at the Port-Royal unit in Paris, > and 113 pairs at > the Antoine Beclere unit in Clamart. All the first twins had > been delivered > vaginally. > > The expectant approach > At the Antoine Beclere, the obstetrics team generally applied > the expectant > approach to delivering the second twin. This is based on > respect for the > natural process of twin delivery: the delivery of the first > twin (twin A), > then an interval of 10-15 minutes marked by a halt to uterine > contractions, > then resumption of contractions and delivery of the second > twin (twin B), > followed by the afterbirth. As the researchers point out in > their paper, the > role of the medical team is to accompany this process, with > "watchful > waiting, fetal heart rate monitoring, external version of the > second twin in > a transverse lie towards the longitudinal, and patience." An > objective is to > avoid maneuvers considered traumatizing (such as total breech > extraction) or > alternatives such as cesarean delivery of twin B. > > The average delay between the birth of two twins at this unit > was 9 minutes. > A total of 51 percent of deliveries were spontaneous, with > intra-uterine > manipulation applied to only 2 percent of the second twins. It > was necessary > to perform a cesarean to deliver the second twin in five of > the 113 cases. > > The active approach > In contrast, the team at the Port-Royal largely applied the > active approach > to delivering twin B, based on the view that time spent in > utero after the > birth of twin A is harmful. "The difficulty of fetal > monitoring and the risk > of acute fetal distress and of retraction of the cervix may > make the second > twin's delivery very difficult, if not impossible," the > researchers note. > The active approach aims to limit the duration of the interval > between the > two births. After the birth of twin A, the artificial rupture > of the > membranes must be followed by twin B's birth, either > spontaneously or > assisted by obstetric maneuvers. > > At the Port-Royal, the average time between the two births was > 5 minutes, > and 43 percent of twin B births involved substantial > intra-uterine > manipulations to assist vaginal delivery. Only 27 percent of > the deliveries > were spontaneous. No cesarean deliveries were performed. > > The Apgar assessment scores of the newborns, at both 1 and 5 > minutes after > birth, were identical at the two units. The proportions of > second twins > transferred to the neonatal intensive care unit were also > similar at both > units, at 18-19 percent. > > "Equivalent" outcomes > After reviewing these and many other indicators of health, the > researchers > conclude: "The neonatal results were similar in both groups, > even though > both the rate of obstetric maneuvers and the interbirth > interval differed > significantly. The two methods therefore appear to be > equivalent when judged > by the second twin's neonatal indicators." > > They call for further research to verify whether an active > approach helps to > avoid or reduce the risk of cesarean delivery. > > The researchers finish by making an important observation > about a risk > associated with the expectant approach that could not be > quantified in the > study: "This risk is the unfamiliarity or loss of clinical > experience with > the obstetric maneuvers involved in version by intra-uterine > manipulations > and total extraction, and thus to be unequipped to perform > them on the day > they are indispensable." They therefore suggest that tertiary > maternity > units promote the active approach to second-twin delivery, to > ensure > adequate training of interns, residents and student midwives. > > > > >From: "Lindsay & Yvette" <[EMAIL PROTECTED]> > >Reply-To: ozmidwifery@acegraphics.com.au > >To: <ozmidwifery@acegraphics.com.au> > >Subject: Re: [ozmidwifery] RE Twins > >Date: Thu, 2 Jun 2005 10:54:38 +1000 > > > > > >Thanks for your reply Lieve. What state are you in? > > > >I'm certainly not keen to let them induce if I get to 38 > weeks. They say > >there is no way of telling the condition of the placenta, and > that there's > >evidence or studies to show significant increase in worse > outcomes after 38 > >weeks or something like that, but I don't know yet what > studies/evidence > >they're relying on re this. I will be asking for details as > soon as they > >let me see someone. > > > >I see with the second one you described there was 1/2 hour > between babies > >for monochorionic diamniotic twins. I'm not convinced about > the 10 minute > >thing either, and they'll have to give me details of what > evidence they're > >relying on if they want me to consider this seriously as > well. > > > >I'm starting to think I should place the onus more on them to > prove to me > >why I should adhere to their "recommendations" rather than > the other way > >around. If they can let me see the info myself I can > consider it, but I > >don't think I should just take their word for it. > > > >I met another pregnant mum yesterday, same type of twins as > me and in a > >public hospital in Melbourne too. She's having the same > issues as me. She > >doesn't want an epidural and has been told she has to have > one. She waits > >up to 2 hours for a rushed 10 minute appointment with an Ob, > then doesn't > >get to ask any questions. We'll be staying in touch; she's > due a few weeks > >before me. > > > >Yvette > >(pg with monochorionic diamniotic twins due 5th Sept). > > > > > > > >>Hello Yvette, > >> > >>I just want to tell you my excperience. I accompagned two > twin births > >>this year in the hospital. We have there very good > supporting obs, that > >>are very confident with breech and twin births. > >>Lieve > > > >-- > >This mailing list is sponsored by ACE Graphics. > >Visit <http://www.acegraphics.com.au> to subscribe or > unsubscribe. > > > Leanne Wynne > Midwife in charge of "Women's Business" > Mildura Aboriginal Health Service Mob 0418 371862 > > > -- > This mailing list is sponsored by ACE Graphics. > Visit <http://www.acegraphics.com.au> to subscribe or > unsubscribe. > Send instant messages to your online friends http://au.messenger.yahoo.com -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
