Perinatal outcome of twin pregnancies among mothers who gave birth in Adama Hospital Medical College, Central Ethiopia

Introduction

Twin pregnancy carries a high risk of pregnancy-related complications including adverse perinatal outcomes. Although evidence from international studies indicated an increased risk of adverse perinatal outcomes in twin pregnancies, little is known about the adverse perinatal outcomes in twin pregnancies and associated factors in Ethiopia. The purpose of this study was, therefore, to estimate the incidence of twin pregnancies and related-adverse perinatal outcomes and identify factors associated with adverse perinatal outcomes in twin pregnancies in Ethiopia.

Methods

A hospital-based retrospective cross-sectional study was conducted among 322 mothers who gave twin birth at Adama Hospital Medical College between 08 July 2015 and 07 June 2017. In this study, the adverse perinatal outcome was defined as the presence of any of the following main conditions: low birth weight, preterm birth, stillbirth, low Apgar Scores, mal-presentation, Admission to neonatal Intensive Care Unit (NICU), and early neonatal deaths. The data were analyzed using SPSS version 20.0. Multivariable logistic regression was conducted to identify factors associated with adverse perinatal outcome at 95% CI or P-value of less than 0.05.

Result

Of 10,850 births recorded in the hospital, 354 births were twins and 322 of these paired records had complete perinatal information. One hundred ninety-nine (61.8%) of the 322 paired birth records had at least one adverse perinatal outcome on one or both twins. Low birth weight was the most common perinatal outcome followed by preterm birth. After adjusting for confounding factors, younger maternal age (AOR = 4.1, 95% CI; 1.3, 12.5) and not having ultrasound scan during antenatal care (AOR = 2.0, 95% CI: 1.2, 3.1) were significantly associated with adverse perinatal outcomes.

Conclusion

The incidence of adverse perinatal outcome in twin pregnancies was high, that is, in 61.8% of twin births, there was at least one adverse perinatal outcome on one or both twins. Moreover, younger maternal age at birth and not having an ultrasound scan during antenatal care were found to be strong predictors for the observed high incidence of adverse perinatal outcomes.

Trends in preterm birth in twin pregnancies in Victoria, Australia, 2007-2017

BACKGROUND

Preterm birth is a major cause of perinatal morbidity and mortality worldwide. In many countries, the preterm birth rate in women with a multiple pregnancy is increasing, mostly due to an increase in iatrogenic preterm birth.

AIMS

To investigate trends in preterm birth in twin pregnancies in Victoria, Australia, in relation to maternal and perinatal complications.

MATERIALS AND METHODS

We conducted a retrospective population-based cohort study in all women with a twin pregnancy who delivered at or after 20 weeks of gestation in the state of Victoria, Australia between 2007 and 2017. Annual spontaneous and iatrogenic preterm birth rates were calculated and trends analysed. Incidence of adverse pregnancy outcomes, maternal complications and risk factors for preterm birth were analysed.

RESULTS

We studied 12 757 women with a twin pregnancy. Between 2007 and 2017 the preterm birth rate increased from 641/1231 (52%) to 803/1158 (69%), mainly due to an increase in iatrogenic preterm birth from 342/1231 (28%) to 567/1158 (49%). This was irrespective of the presence of pregnancy complications. Our study showed neither a decrease in perinatal mortality from 28 weeks of gestation nor in preterm average weekly prospective stillbirth risk.

CONCLUSION

Preterm birth rates in twins in Victoria are increasing, mainly driven by an increase in iatrogenic preterm birth. This occurred both in complicated and non-complicated twin pregnancies, and has not been accompanied by reduction in perinatal mortality from 28 weeks.