Objectives: The aim of this study was to determine the timing of neonatal cardiac intervention in babies with antenatally diagnosed congenital heart disease and the impact on obstetric management. Methods: A retrospective review of all deliveries between January, 2008 and December, 2009 was conducted in a tertiary centre with foetal and paediatric cardiology, maternal–foetal medicine, and obstetric units. All live births with antenatally detected congenital heart disease were included. Data were collected from foetal, paediatric cardiology, and maternity databases and records. Induction, delivery mode, and timing of the first cardiac intervention in the neonate were studied. Results: 205 deliveries were included. Induction and elective Caesarean section rates were 51.2% (105/205) and 14.1% (29/205), respectively. The vaginal delivery rate was 56% (115/205). There was a non-significant trend towards a higher rate of vaginal delivery after spontaneous labour than after induction (75% versus 66%; p = 0.234). The rate of neonatal cardiac intervention during the initial stay was 59.5% (122/205); it was 18.5% (38/205) within 48 hours and 25.8% (53/205) within 72 hours. The median time to first intervention was 4 days (interquartile range 2–8). Babies with hypoplastic left heart syndrome (median 3, interquartile range 2–6), transposition of the great arteries (median 1, interquartile range 0–4.5), and arrhythmia (median 0.5, interquartile range 0–1) had a significantly earlier time to first intervention compared with those with other conditions (p = 0.001). Conclusion: Vaginal delivery can be achieved in women delivering babies with major congenital heart disease at a tertiary centre. Delivery in or near a tertiary centre is recommended for patients requiring early intervention, of which many can be identified in advance.

There were 150 deliveries of twin pregnancies over 26 weeks in our hospital. The incidence of twin pregnancies was 1.0% in a population consisting of Greek nationals. Seventy five (50%) were term at delivery whereas 75 (50%) were premature (mean gestational age at delivery 36.5 weeks). The birth weight at delivery ranged from 350 grs to 4,050 grs with mean birth weight for the 1st and 2nd twin of 2,404 grs and 2,384 grs, respectively. One hundred and forty four (48%) neonates had weights between 1,501 to 2,500 grs. Twenty two (9.57%) neonates had weights between 1,501 grs to 2,500 grs. The perinatal mortality when birth weights exceeded 1,500 grs was 7.32%. In total, 186 (62%) newborns were delivered vaginally and 114 (38%) by cesarean section. Forceps were used in 4.33% of the cases and breech extraction was performed in 2.33%. The mode of delivery and perinatal mortality rates were not correlated for both twins (p>0.05). The most common causes of death were hyaline membrane disease (48.5%), immaturity (18.2%), congenital abnormalities (15.1%), septicemia (12.1%) and asphyxia (6.06%). Prematurity seems to constitute the most common cause of perinatal deaths while the mode of delivery found to be irrelevant to perinatal mortality.

During the 10-year period, 1975-1984, 105 triplet pregnancies were delivered at Harare Maternity Hospital, Zimbabwe, among 286,338 pregnancies in the Greater Harare Unit, giving an incidence of triplets of 1:2,727. The mean gestational age at delivery was 32.5 wk with 81 women (77.1%) delivering before 37 wk. Primigravidas delivered at a significantly earlier mean gestational age (P < 0.05) and had a higher perinatal mortality (P < 0.001) compared with grand multigravidas. Of the 315 babies, 277 (87.9%) weighed < 2500 g. The overall perinatal mortality rate was 327‰, with a pernital mortality rate of 146‰ for infants weighing ≥ 1000 g. Women hospitalised for bed rest during the antenatal period had fewer perinatal deaths compared with those diagnosed during the antenatal period, but not hospitalised for bed rest (P < 0.02). No difference was found in the mean gestational age at delivery or the mean birth weights between these two groups. Among infants ≥ 28 wk gestation there were fewer perinatal deaths in triplets delivered by cesarean section compared with triplets delivered vaginally (P < 0.0004). This suggests that cesarean section may offer the optimal mode of delivery in triplet pregnancy.

No consensus exists for the optimal mode of delivery for twin fetuses. Opinions vary by type of institution (university medical center vs community hospital), country or continent (North America vs Western Europe) and personal preference of individual physicians. This article lists clinical considerations in arriving at the decision and presents them in the form of a decision tree.