Maternal complications in twin pregnancy; recent trends: a study at a tertiary care referral institute in Northern India

Abstract

Background: This study aims to determine the maternal complications in twin pregnancy in North Indian population at tertiary institute.Methods: This was a retrospective cohort review of multiple pregnancies after 20 weeks gestation at a tertiary teaching hospital (2011-2015). Maternal data was collected from the labor room delivery data entry register and patient’s admission file. Patients with diabetes mellitus and chronic hypertension were excluded from the study.Results: Out of 19539 births during this period, 432 were twin pregnancies with an incidence of 22/1000 birth. Most of them were 282 (65.4%) were referred patients. Eighty seven percent patients were in the age group of 21-30 years and primigravida contributed to 45.7% of total patients. Maternal complications noticed were as preterm deliveries in 304 (70%), anaemia in 259(60%) patients, preterm rupture of membranes in 120 (39.4%) patients, hypertensive disorders of pregnancy in 122(28.3%) patients, cholestasis of pregnancy in 24(5.5%) of patients, hypothyroidism in 22(5.1%) of patients, antepartum hemorrhage (APH) in 20(4.6%) and gestational diabetes mallitus (GDM) in 08(1.8%) of patients. Among postpartum complications, atonic postpartum haemorrhage (PPH) was observed in 44 (10.2%) and maternal mortality happened in 02(0.46%) cases.Conclusions: This study reveals higher percentage of, preterm labor, anaemia, and gestational hypertension than other studies. More number of intensive care unit should be established in high prevalence areas to prevent perinatal mortality due to prematurity. Treatment of anaemia requires more aggressive approach by considering intravenous iron whenever compliance is in doubt. Frequent antenatal care is required for early diagnosis of these complications to prevent maternal and fetal morbidity.

Maternal and neonatal outcome of twin pregnancy at a tertiary care center

“…[22][23][24] Our study reports 66% primigravida and 34% multigravida which is contrary to already published study in which 84.2% were multigravida another study reported 45.7% primigravida and 54.3% multigravida. 25,26 Studies reported preterm delivery in 60% and 67% of twin pregnancies and few other studies reported even lower 38%29 and 44%30, which is in line with our study. Studies have reported cesarean section (LSCS) in 68%, 49% and 45% where as our study reports it as 92%.…”

Twin pregnancies: a retrospective analysis

“…Dubey et al had 45.7% primigravida and 54.3% multigravida. 6,8 Mean gestational age at delivery in our study was 34.53 weeks which was comparable with Erdemoghu et al and Yuel et al 9,10 Hypertensive disorder in pregnancy (40.90%) was the most frequent complication associated with twin pregnancy in our study. 24 to 30 % was noticed by other workers.…”

“…Maximum age group with twin pregnancy was between 20 -29 years (56.06%) in our study whereas 86.9% and 81% in Dubey et al and Tomar et al respectively. 6,7 This shows that maximum women who sought ART treatment are below 30 years.…”

“…13 80.30% women had preterm delivery (spontaneous or induced) while 70% and 67% was found by other authers. 6,11,17 Some researcher had lower incidence of preterm twin delivery i.e 50.7% and 41.5%. 18,19 This high incidence is due to mostly IVF pregnancies with comorbidities requiring induction and PPROM.…”

Twin pregnancy a complicating journey for both mothers and babies: elaborate review

“…Multiple birth babies have a two times higher chance of having birth defects such as neural tube defects, cardiac defects and gastrointestinal defects, compared to single birth babies. 17…”