Twin pregnancy is increasing as infertility treatment is widely given nowadays using assisted reproductive technologies. Twin pregnancy is a risk factor for some complicated pregnancies and it may also cause a hard labor. Although cesarean delivery is frequently indicated in many hospitals in Japan for twin pregnancy in view of the risk of vaginal delivery of the second baby, we have tried vaginal delivery of twin pregnancy in a certain situation. We studied the methods of twin delivery, its outcomes and the early neonatal condition.
  We found 251 twin deliveries (4.6%) in a total of 5,464 deliveries after 22 weeks of pregnancy from January 2005 to December 2009 in the delivery record. Forty-six percent of women pregnant with twins delivered their babies after 33-36 weeks of pregnancy and 41% after 37 weeks of pregnancy. Sixty-five percent delivered by Cesarean section, 33% by vaginal delivery, and 2% vaginally for the first baby and by Cesarean section for the second baby. Fifty percent of the Cesarean deliveries were performed as patients so desired. Ninety women pregnant with twins chose vaginal delivery in which 92% (64/69) of vertex/vertex presentation and 86% (18/21) of vertex/ breech presentation succeeded in vaginal delivery. Neonatal outcome was assessed in 90 vaginally deliveried babies by use of the Apgar scoring system. One-minute Apgar scores of 0-3 (severe asphyxia) were given to 4.5% (8/180) of babies and scores of 4-6 (moderate asphyxia) to 3.3% (6/180) of babies. The incidence meant that a mother had 8.9% and 6.7% of high risk of severe and moderate asphyxia of her babies. But severe asphyxia decreased to 1.7% (3/180), moderate asphyxia to 1.1% (2/180) of babies on the assessment of 5-minute Apgar scores that reflected long-term neonatal outcome. Eleven cases were second babies of all 14 cases of asphyxia on the assessment of 1-minute Apgar scores. In the vaginal delivery group, 5 cases of umbilical cord prolapsed and 3 cases of placental abruption occurred in second babies. In conclusion, twin delivery should be attempted at the birth center where neonatologists and anesthesiologists are available 24 hours as extra-emergency Cesarean delivery can be performed because of the high incidence of emergency Cesarean delivery of second baby (5.6%) and asphyxia of neonates delivered vaginally.

It is important to understand the impact of the COVID-19 pandemic on inpatient care and the needs of inpatients and their families. We conducted an anonymous self-administered questionnaire survey of inpatients who had been referred to our palliative care team, their families (hereafter referred to as patients' families), and their primary nurses (hereafter referred to as PNs). The EZR statistical software was used for statistical analysis, and p<0.05 was considered to indicate a significant difference. 31 patients [9 males, 22 females; median age 65 years (range 30-85 years)], 25 family members, and 26 PNs responded. The question “Do you ever feel depressed due to restricted visitation?” had a significantly stronger impact on patient families than on patients (p<0.05). Compared to patients, patient families tended to prefer face-to-face visits (p<0.05). The impact of visitation restrictions was greater on patients’ families than on the inpatients, suggesting that it is important to provide care and support to patients’ families especially during periods when there are visitation restrictions.