True statement regarding twin delivery is:
Correct Answer: Second twin has more chances of developing polycythemia
Description: Twin pregnancy in general is associated with higher incidence of perinatal morbidity and mortality.
Perinatal mortality in twins is 5 times greater than in singleton pregnancies.
Perinatal mortality in twins varies with birth order and the type of placentation.
“Second twins do not do as well as the first twin…perinatal mortality being 9% for the first twin and 14% for the second twin”.
Fernando Arias 3/e, p 297
Also monochorionic—monoamniotic twins have a poor prognosis, perinatal mortality being 50%.
Now with this background lets see each option separately.
Option a: First twin has more chances of asphyxia—incorrect as:
“Asphyxia and stillbirth are more common (in twin pregnancy) due to increased prevalence of pre-eclampsia, malpresentations, placental abruption and increased operative interferences. The second baby is more atrisk.
Dutta Obs. 7/e, p 206
Option b: Second twin has more chances of developing polycythemia:
This statement can be true as second baby has more chances of asphyxia which can stimulate erythropoeisis in the second twin. Also there are chances of bleeding from the first twin into the second twin in case of monochorionic twins which can cause polycythemia.
Option c: Second twin has more chances of developing hyaline membrane disease—this is incorrect as is evident from the following lines of Williams:
“As measured by determination of the lecithin and sphingomyelin ratio, pulmonary maturation is usually synchronous in twins.”
Williams 23/e, p 880
Hence second twin does not have increased chances of developing hyaline membrane disease.
Coming to the last option—Increased mortality in first twin (option d)
Category:
Gynaecology & Obstetrics
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