Fetomaternal Outcome in Twin Pregnancies: A Retrospective Analysis from a Tertiary Care Center QC01-QC05
149, Banshipuri, Jagatpura, Jaipur, Rajasthan, India.
Introduction: Twin pregnancies are among the major challenges faced by obstetricians globally. Increased maternal and fetal morbidity is observed with an increase in the incidence of twin pregnancies. Due to elevated rates of complications, a larger number of cesarean sections are performed in twin pregnancies in comparison to singleton gestation.
Aim: The study aimed to find out the incidence of twin pregnancy with associated maternal risk factors and fetal outcome in the study population.
Materials and Methods: This retrospective observational study was carried out at JNU Hospital and Medical College, Jaipur for a period of 4 years from December 2015 to December 2019. A total of 70 mothers, who presented with twin pregnancy, were included in this study. Data were collected from hospital records regarding maternal age, parity, whether spontaneous or assisted conception, gestational age, pregestational Body Mass Index (BMI) and family history. Details of maternal and fetal complications that occurred during the antenatal period and labour as well as the mode of delivery were collected and analysed. Statistical significance was considered if the p-value was ≤0.05. Qualitative data were represented as rate and proportions, while quantitative data were represented as mean and standard deviation.
Results: A total of 70 mothers with twin births, resulting in 140 babies during the 4 years study period were included. A total of 4240 deliveries overall during the study period, gave a twin pregnancy incidence rate of 16.5 in 1000 deliveries. Preterm labour (25.4%), anaemia (26.8%) and hypertension (22.5%) were common problems. The most common indication for cesarean delivery was fetal malpresentation (37.8%) The mean weight of the first twin was 2.12±0.35 kg while the mean weight of the second twin was 1.97±0.30 kg. Among fetal complications, Intrauterine Growth Restriction (IUGR) was seen in 11.4% and birth weight discordance in 21.4% of children. A low Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score was noted in 21.4% of babies, while 12.9% of babies died in the early neonatal period.
Conclusion: Maternal complications during twin pregnancy were mainly preterm labour, diabetes, hypertension, and anaemia. Cesarean section was the main mode of delivery in this study with significant association with hypertension and preterm labour. Fetal complications were in the majority related to IUGR. More vigilance during the antenatal period and labour is needed for proper selection of mode of delivery. Active fetal surveillance and intervention with appropriate neonatal care can improve fetomaternal outcome.