Perinatal Outcome of the Second Twin in Twin Pregnancies in a tertiary care hospital

Background: Twin pregnancies are associated with elevated risks for both maternal and fetal complications. Among these, the second twin often encounters higher rates of adverse perinatal outcomes, including lower Apgar scores and increased perinatal mortality. While extensive research from Europe and North America has illuminated these risks, limited data are available from the Indian context. This study aims to bridge this gap by evaluating the perinatal outcomes of the second twin in a South Indian population. Objective: To assess the perinatal outcomes of the second twin in twin pregnancies, with a focus on gestational age, chorionicity, mode of delivery, and birth weight as influencing factors. Methods: This retrospective observational study was conducted over a one-year period (April 2023 – March 2024) at Government General Hospital, Kakinada. A total of 93 twin pregnancies beyond 28 weeks’ gestation were included, excluding cases involving intrauterine death of one fetus or congenital anomalies. Data on maternal and fetal characteristics were analyzed using chi-square tests to identify significant associations. Results: The perinatal mortality rate of the second twin was 12.9%, compared to 7.5% for the first twin, with prematurity identified as the leading cause of mortality. Maternal age emerged as a significant determinant of perinatal outcomes, whereas factors such as parity, gestational age, and birth weight showed no statistically significant impact. Conclusions: Second twins in twin pregnancies are at an elevated risk for adverse perinatal outcomes, predominantly due to complications of prematurity. These findings underscore the necessity for vigilant monitoring and individualized care, particularly for younger mothers, to optimize outcomes in twin pregnancies.