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To investigate factors associated with outcome of second twin during labour. The study was a retrospective cohort study in a single tertiary centre in Malaysia from 2014 until 2018 involving all twin pregnancies delivered at or more than 24 weeks of gestation. Total of 409 twin pregnancies were included. Dichorionic twin comprises of 54.5 % (n=223) and 45.5 % (n=186) are monochorionic. Women with dichorionic pregnancies are significantly older (p<0.001), have more pre-existing medical disorders (p=0.011) and fetal structural anomalies (p=0.009). Monochorionic pregnancies are significantly more amongst Malay (p=0.01) and conceived spontaneously (p<0.001). There are significantly more fetuses both in cephalic presentation (p=0.026), birthweight discrepancy more than 20 % (p=0.038) and shorter mean inter-twin delivery duration (p=0.048) in monochorionic pregnancies. Second twin delivered with Apgar score <7 is significantly more in dichorionic pregnancies (p=0.006). The second twin is associated with lower birthweight, small for gestational age and arterial cord pH<7.25. Within the group of women who delivered both fetuses vaginally, there was significantly more second twins with intertwin delivery duration less than 30 min who were delivered vaginally without instrumentation (p=0.018). There was significantly more second twin with intertwin delivery duration of 30 min and more with arterial cord pH<7.25 (p=0.045). Those who delivered spontaneously had inter-twin delivery duration within 15–29 min. The outcome of second twin is not influenced by type of twin, gestational age at delivery, inter-twin delivery duration, mode of delivery and presentation at birth. The neonatal outcome for the second twin at birth is not influenced by type of twin, gestational age at delivery, inter-twin delivery duration, mode of delivery and presentation at birth in a cohort managed with non-active management of the second twin in Malaysia. [ABSTRACT FROM AUTHOR]

Introduction: Every pregnant mother has a different expectation on each laboring experience and would want to imagine a pleasant journey about giving birth. A good childbirth experience boosts self-confidence, self-worth and feeling accomplishment. A bad childbirth experience leads to postpartum depression, fear of childbirth and some even experience post-traumatic stress disorder. Induction of labour (IOL) is a common procedure in obstetrics practice, done prior to onset of labour using mechanical or pharmacological methods. This questionnaire-based study was planned in order to improve our approach and service in making women more comfortable during the childbirth process albeit spontaneously or through IOL. Objective: To compare childbirth experience among induced labour and spontaneous labour and to evaluate their contributing factors. Methods: This was a cross sectional study where questionnaire was distributed to all postpartum women who had delivered in Hospital Cansellor Tuanku Muhriz who fulfilled inclusion and exclusion criteria. Suitable participants were identified at postnatal ward just after delivery. Results: A total of 314 women were recruited. Study showed no significant labour experiences difference among both IOL and spontaneous labour groups. Overall, both spontaneous and IOL groups had positive childbirth experience. Age, ethnicity body mass index labour analgesia and indication of IOL has influence in childbirth experiences. Conclusion: Childbirth experiences were comparably positive in both groups possibly due to patients understanding of labour process and healthcare factors. [ABSTRACT FROM AUTHOR]

Brain metastases during pregnancy poses complex conundrum in management. Stereotactic radiosurgery (SRS) offers valuable option to clinicians in this scenario. We reviewed and described the safety and effectiveness of Gamma Knife (GK) SRS in treating a solitary cerebellar metastasis in a patient with recurrent breast cancer at 28 weeks of gestation. Following multidisciplinary discussion, she consented for urgent single session GK SRS to the brain metastasis with 2 cycles of 3-weekly paclitaxel chemotherapy prior to planned delivery at term. Prior to the frame-based treatment, a trial run with dosimeters placed on the superior and inferior parts of foam knee support showed radiation exposure of 3.12 mSv and 1.06 mSv respectively. A prescription dose of 16 Gy at the 50% isodose was delivered using 24 isocentres over 39.7' of beam on time. The treatment plan had 98% coverage, 89% selectivity and a gradient index of 2.98. Dosimeters placed near the uterine fundus and suprapubic region (consistent with location of fetal head) during the actual treatment recorded 2.83 mSv and 0.27 mSv, which is lower than the trial dosimeter readings. The patient successfully completed SRS treatment and gave birth to a healthy baby two months later. Follow-up MRI at three months interval showed total resolution of the lesion. GK SRS is known for the lowest extracranial dose compared to other SRS modalities. This report and literature review confirmed that GK is a sharp and effective, yet gentle and safe treatment for pregnant patients with brain metastases., Competing Interests: We acknowledged the contributions of all medical and healthcare professionals from all subspecialties in the management of this complex case. Part of the data in this case report has been presented in a regional conference in the form of online oral presentation in February 2023, but not published in any proceedings. Authors’ disclosure of potential conflicts of interest The authors have nothing to disclose., (© 2024 Old City Publishing, Inc.)