The Second Twin: Outcomes and Lessons in a Northern Nigerian Tertiary Hospital

Twin pregnancy is traditionally high risk, and with rising incidence, there is a need for evaluating the outcomes as a marker of the quality of care offered. There is some evidence to suggest that the second twin is at higher risk of adverse fetal outcomes, though several studies, especially in more advanced healthcare settings, have debunked this. There is a need for robust evidence on second twin outcomes in low-resource settings like ours to enable standardization and improved quality of care, which will lead to improved fetal outcomes. The objective of this study is to compare the delivery outcomes of first and second twins in terms of Apgar scores and stillbirth rates.

The records of women who presented with twin gestation to the delivery suite, from January 2016 to December 2022, were retrieved using a structured proforma. Delivery outcomes were the Apgar scores at one and five minutes, and stillbirth rates.

The most common presentation of the second twin was cephalic, and the mode of delivery was via CS. There was no statistically significant difference in Apgar score and stillbirth rate between the first and second twins. However, in those that had vaginal deliveries, the first- and fifth-minute Apgar scores were significantly lower in the second twin than the first twin.

There were no significant differences in adverse fetal outcomes between the first and second twins in the general population. However, the second twin may be at higher risk of birth asphyxia in twins delivered vaginally.