Epidural Analgesia and Delivery of Second Twin

Study Overview
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Brief Summary
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Over an 8-year period, 124 twin pregnancies at gestational age ≥32 weeks with both twins presenting as a vertex and eligible for vaginal delivery were reviewed. Excluded were patients with the following intrapartum factors which may affect mode of delivery of second twin: 1. Presentation of the 2nd twin: breech or other than vertex; 2. Monochorionic twins; 3. Induction of labour; 4. difference in foetal weight between twin B and twin A ≥25%. The chi-square statistic was used to compare differences in the incidence of retained second twin between the groups.

Detailed Description
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The investigators conducted this prospective study in women with twins pregnancy planned for trial of vaginal delivery and gave birth between January 2014 and December 2019, in the Department of obstetrics and Gynaecology of the Sabah Maternity Hospital, Sabah Specialized Area, Kuwait. The Sabah Maternity Hospital is a tertiary care hospital for the country of Kuwait with approximately 12500 deliveries per year. The study protocol was approved by the Ethics Committee.

Official Title
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Epidural Analgesia and Delivery of Second Twin: Prospective Observational Study

Conditions
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Epidural, Analgesia, Labor Pain

Intervention / Treatment
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* Drug: Bupivacaine-fentanyl


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: .gestational age of 32 weeks, determined by an early ultrasound performed in the second trimester or certain last menstrual period; (2) both twins viable; (3) eligibility for vaginal delivery as defined by twin A being cephalic; and (4) no previous cesarean section. Exclusion Criteria: underwent an elective or repeat cesarean section presentation of twin B at delivery other than cephalic (breech, oblique or transverse presentation induction of labour the difference in foetal weight between twin B and twin A at delivery ≥25% .Neonates were excluded if one was stillborn or had major congenital malformations.

Ages Eligible for Study
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Minimum Age: 16 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Vaginal Delivery<br>Delivered both twins vaginally | Drug: Bupivacaine-fentanyl<br>* Initial epidural bolus of 10 ml Bupivacaine 0.125% plus 50 mcg Fentanyl, followed by continuous infusion pf Bupivacaine 0.0625%™ plus 1mcg/dl Fentanyl<br>* Other names: Epidural Catheter insertion;|
| C-Section Delivery<br>Delivered both twins by Cesarean Section | Drug: Bupivacaine-fentanyl<br>* Initial epidural bolus of 10 ml Bupivacaine 0.125% plus 50 mcg Fentanyl, followed by continuous infusion pf Bupivacaine 0.0625%™ plus 1mcg/dl Fentanyl<br>* Other names: Epidural Catheter insertion;|
| Vaginal/C-Section Delivery<br>Delivery first twin vaginally and second twin By C-Section. | Drug: Bupivacaine-fentanyl<br>* Initial epidural bolus of 10 ml Bupivacaine 0.125% plus 50 mcg Fentanyl, followed by continuous infusion pf Bupivacaine 0.0625%™ plus 1mcg/dl Fentanyl<br>* Other names: Epidural Catheter insertion;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Delivery of First twin | Vaginal or C-Section | 24 hours | 
| Delivery of Second twin | C-Section or C-Section | 24 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Epidural, Analgesia, Labour