Maternal fetal outcome in multiple versus singleton pregnancies delivered in a teaching hospital

Abstract

To compare the maternal and fetal outcome in multiple versus singleton pregnancies in a private teaching hospital in India. Prospectively collected data on 50 twin deliveries from July 2018 to November 2021 were studied to determine its incidence; the maternal and foetal outcome, and compared with 50 singleton deliveries conducted on same day following the twin delivery who served as controls, the twins were also analysed on the basis of chorionicity. A total of 3415 deliveries were conducted during the study period, of which 50 were twin deliveries, giving an incidence of 14 per 1000 births or 1.4:100 deliveries. Six among 50 twins resulted following ovulation induction. Women with twin gestation had a mean maternal age of 24.7±3.71, same for the singleton mothers was 24.26±3.7years; mean gestational age at delivery for twins and singletons were 35.38±2.6 and 38.63±1.19 weeks; mean birth weight for twins and singletons were 2.193kgs and 2.85±0.46kgs, mean parity were 2.04± 1.0 and 1.72±0.7 respectively. Parity, gestational age, NICU stay characteristics showed p value < 0.05. Compared with singletons, women with twin gestations had a positive risk association with odds >1 for anaemia, preeclampsia, preterm labour, malpresentation and caesarean delivery. Twin Neonates suffered prematurity, low birth weight, congenital anomaly, prolonged NICU care and increased perinatal death. Neonatal risk was more among monochorionic twins than dichorionic twins. There were 3 cases with single fetal demise, and both fetuses IUD in another case, (total IUDs-5), one twin was still born, two had early neonatal death and there were two late neonatal (>7 Days) deaths. One twin mother threw fits on the 6th postpartum day. Another mother received 20 units of blood and component replacement and subtotal hysterectomy for PPH. Despite improvement in antenatal and neonatal care, twins pose a higher threat to MCH outcome. Hence, thorough counselling, patient awareness, more vigilance at interpretation of antenatal tests, intrapartum monitoring and bridging the gap between demand and supply at NICU facility can improve maternal and neonatal outcome; as well as can help parents cope with the psychological stress.