OBJECTIVE:To compare pregnancy outcome in twin pregnancies with and without hydramnios. STUDY DESIGN:A database of women receiving outpatient preterm labor surveillance services was studied for the period 1988 to 2002. Included were women with twin gestations under 30 weeks' gestation at start of outpatient services. We compared pregnancy outcomes for twin gestations with hydramnios (n ¼ 201) to twin gestations that had normal amniotic fluid volume (n ¼ 13,111). RESULTS:Obstetrical and perinatal outcomes in twin pregnancies were adversely affected by the presence of hydramnios. Delivery was shifted to earlier gestations in women with hydramnios (32.8 vs 35.1 weeks, p<0.001), especially under 32 weeks (38.3 vs 12.7%). Perinatal loss was notable in women with hydramnios: stillbirths (12.7 vs 1.1%, p<0.001) and neonatal mortality (7.5 vs 1.1%, p<0.001). CONCLUSIONS:Hydramnios in twin gestations negatively impacts gestational age at delivery. The incidence of perinatal mortality is significantly increased in the presence of hydramnios.

Uterine size alone is not an absolute contra-indication to vaginal hysterectomy. Large uterine size (greater than 300 g) was not related to a significant increase in failed vaginal hysterectomy. Conversely, failed vaginal hysterectomy was not size-dependent. Furthermore, there is no additional operative morbidity when vaginal hysterectomy is converted to a total abdominal hysterectomy because of a technical inability to complete the surgery vaginally.

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