Pregnancy Outcome of Multiple Gestation at the University of Port Harcourt Teaching Hospital, Nigeria: A 5-Year Review.

Abstract

Multiple pregnancies are considered as high-risk pregnancies due to the increased associated maternal and fetal morbidity and mortality. The incidence of multiple pregnancy varies from region to region, with a very high incidence recorded in Nigeria and other African countries. The aim of this study was to determine the prevalence and the feto-maternal outcome of multiple pregnancies. This was a retrospective study of all pregnant women who had multiple gestation at the University of Port Harcourt Teaching Hospital from January 1, 2012 to December 31, 2016. Data was obtained from the case notes and the special care baby unit (SCBU). The data obtained was entered into a spread sheet and analyzed using SPSS 22. Results are presented in simple percentages and tables. The P value was set at < 0.05. During the period under review there were 9,895 deliveries, of which 287 were multiple pregnancies, giving a multiple pregnancy rate of 29/1000 deliveries. The mean age of the women was 29.0 ±4.3 years, while the mean parity was 1.6± 1.5. Majority (85%) of the pregnancies were achieved spontaneously, while 15% were achieved through assisted reproductive technology. Twin pregnancies made up 92.1% of multiple gestations. The most common antenatal complication was pregnancy induced hypertension (22%). The caesarean section rate was 71%, the most common indication for caesarean section was abnormal lie and presentation of the leading twin (26.3%). About half (53%) of the babies were delivered preterm, with a mean gestational age at delivery of 35.1± 1.5 weeks. Of the 558 babies delivered, 52.3% had low birth weight. There were 43 perinatal deaths, giving a perinatal mortality rate of 77/1000 total births. Perinatal mortality was significantly associated with prematurity (0.0001) and booking status (0.0001). There were three maternal deaths, giving a maternal mortality ratio of 556.04/ 100,000 live births. All the maternal deaths were in unbooked patients. Multiple pregnancy is a high-risk pregnancy, associated with a high rate of perinatal and maternal morbidity and mortality. It is recommended that women with multiple pregnancy should have supervised antenatal care and delivery in a facility with good obstetric and neonatal intensive care services.