title: [Delivery in twin pregnancies. The experience of the obstetrics department of Aziza Othmana's Hospital, about 117 cases].
abstract: BACKGROUND
  The conduct and delivery of twin pregnancies are interspersed with as well as maternal fetal and neonatal complications. The obstetrician is faced with the birth of 2 children often fragile and a uterus often exposed to dynamic dystocia.
  
  
  OBJECTIVE
  To study the maternal and newborn morbidity and mortality in twins, in order to clear the optimal route of delivery in such circumstances.
  
  
  METHODS
  A retrospective study over a period of 3 years (1 January 2005 to December 31, 2007), about 117 twin pregnancies. Inclusion criteria were a term exceeding 28 weeks and fetuses alive. We analyzed maternal complications during and after delivery and neonatal complications.
  
  
  RESULTS
  Maternal complications were significantly more frequent in case of caesarean section. The frequency of perinatal complications (Apgar score, respiratory distress, immediate neonatal resuscitation and neonatal intensive care unit transfer) in the first twin was not influenced by the route of delivery as opposed to the second twin which Apgar score's alters when vaginally. The newborns of low birth weight (<1,500 Kg) and those whose term was less than 32 weeks were more at risk of an Apgar score <7 (at 1 and 5 minutes), respiratory complications, need for immediate resuscitation and transfer to intensive care and that statistically significant both for the 1st and the 2nd twins.
  
  
  CONCLUSIONS
  The twins pregnancies' morbidity appears to be more related to prematurity and intra uterine growth retardation) more than to the mode of delivery and hence the interest to detect and prevent its anomalies. It seems that vaginal delivery has a deleterious effect at least for the second twin but cesarean section doesn't seem to be the solution. Better learning techniques and obstetric maneuvers would reduce morbidity.
authors.affiliation: Hopital Aziza Othmana, Faculte de Medcine de Tunis, Tunis El Manar.
authors.forename: Anis
authors.initials: A
authors.lastname: Fadhlaoui
authors.forename: Amina
authors.initials: A
authors.lastname: Hassis
authors.forename: Mohamed
authors.initials: M
authors.lastname: Khrouf
authors.forename: Monia
authors.initials: M
authors.lastname: Ferchiou
authors.forename: Anis
authors.initials: A
authors.lastname: Chaker
authors.forename: Fethi
authors.initials: F
authors.lastname: Zhioua
mesh_terms: D000293:Adolescent; D000328:Adult; D001034:Apgar Score; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D006748:Hospital Departments; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D011247:Pregnancy; D059285:Pregnancy, Twin; D012151:Resuscitation; D012189:Retrospective Studies; D014416:Tunisia; D055815:Young Adult