Perinatal mortality in retained second twin

Retention of the second twin is diagnosed if the twin is still undelivered 30 minutes after the birth of the first baby and this condition constitutes an obstetric emergency often associated with a poor outcome. We report the causes of retention and the perinatal mortality rate in 30 retained second twins in a series of 128 sets of twin births recorded in Mansa General Hospital (Zambia) from 1 August 1993 to 31 July 1995. The study focused only on 125 available case notes. The incidence of twin birth is 4% of deliveries and 24% second twins were retained. The main causes of retention were uterine inertia (90%), malpresentation (60%) and home delivery of the first twin (23%). The perinatal mortality rate was higher in retained second twins (47%) than in those delivered normally (13%). The main factors associated with perinatal deaths were very low Apgar score (100%), cephalic presentation (64%) and very low birth weight (29%). Only good antenatal and intrapartum care can help reduce the incidence and poor outcome due to the retained second twin.