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Abstract
Introduction: Twin pregnancy is associated with more pregnancy complications and poorer
pregnancy outcome than singleton pregnancy.
Aim: To evaluate the maternal and fetal complications in twin pregnancies.
Materials and methods: 300 Twin Pregnancies were studied over a period of 16 months from 2006-
07 to evaluate complications to the mother and both fetuses. Data obtained at the time of delivery
included maternal age, parity, gestational age at the time of delivery, mode of delivery and fetal
weights.
Results: Among 25754 deliveries in 16 months we had 300 twin pregnancies, incidence being 1:85.
Incidence of twins in percentage was 1.16%. Majority of women were in the age group of 20-25 years
and majority of women gestational age 28- 32 weeks. Almost half of the twin pregnancies were
unbooked cases. Out of the twin deliveries 50.3% were unbooked cases where as 49.6% were booked
cases. Ratio of Primigravidae and multigravidae was 2.4:1 respectively. The most frequent maternal
complication was pregnancy induced hypertension which occurred in 39.3% of cases. Other common
complications encountered were premature rupture of membranes (10%) and anemia (6.3%). The
commonest fetal complication was preterm labour accounting in 130 (43.3%) cases and with
malpresentations in 87 (29%) cases followed by severe discordancy in 26 (12.4%). The highest
perinatal mortality rate was 28/97 in low birth weight group i.e., 1-1.5 kg and high survival rate was
seen in >2.5 kg body weight children.
Conclusion: Twin pregnancies are significant risk factor for maternal and fetal complications include
pregnancy induced hypertension and prematurity respectively.
Key words
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Mahita Reddy A., Madhavi KSS., Niharica. A study on risk of twin pregnancy. IAIM, 2016; 3(10): 139-145.
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Mahita Reddy A., Madhavi KSS., Niharica. A study on risk of twin pregnancy. IAIM, 2016; 3(10): 139-145.
Total number of Number of twin The number of twins Report of twins pregnancies
births pregnancies in percentage in 1000/births
25754 300 1.16 11.64
Almost half of the twin pregnancies were The peak age incidence as per Table - 1 was the
unbooked cases. Out of the twin deliveries 20-25 year group, which accounted for 180
50.3% were unbooked cases where as 49.6% (60.0%) cases and, youngest being 18yrs old and
were booked cases. Ratio of Primigravidae and eldest being 37 years .While the modal parity
multigravidae was 2.4:1 respectively (Table - 2). was Para 0, with the lowest in the Para 4 group
Delivery at 36-37 weeks is associated with (Table 2, Table - 3). Incidence of twin births
lowest risk of fetal death. was 1:85.
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Mahita Reddy A., Madhavi KSS., Niharica. A study on risk of twin pregnancy. IAIM, 2016; 3(10): 139-145.
was 1:85. Delivery at 36-37 weeks is associated like preeclampsia, PROM, IUD of one twin and
with lowest risk of fetal death. Risk of cerebral delivery before 32 weeks of gestation.
palsy is 3 times increased due to various factors
50
44.7%
40
30
20
10
0
Vaginal delivery Total Caesarean delivery
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Mahita Reddy A., Madhavi KSS., Niharica. A study on risk of twin pregnancy. IAIM, 2016; 3(10): 139-145.
Table - 4: Maternal and fetal complications. Preterm labour (43.3%): Prematurity is the
leading cause of neonatal death among twin
Maternal No. of patients % gestations. The higher rate of preterm delivery
complications (N-300) compromises the survival chances of the
Pregnancy induced 118 39.3 neonates and increases their risk of lifelong
hypertension disability. Multiple births account for about 20%
Premature rupture of 30 10 of all the preterm births.
membranes
Anaemia 19 6.3 Malpresentations (29%): They are common in
Hydramnios 18 6 twin pregnancies and more so in the second twin
Oligohydramnios 13 4.3 when compared to first.
Antepartum 11 3.6
Hemorrhage Discordancy (33%): Etiology of discordancy
Postpartum 9 3 may be IUGR, Twin to twin transfusion
Hemorrhage syndrome, Congenital anomalies. Neonatal
Eclampsia 7 2.3 mortality is increased with increasing degrees of
Fetal Compilations discordancy regardless of mode of delivery. But
in severe cases of discordancy, caesarean
preterm labour 130 43.3 delivery is preferred as the neonatal mortality
malpresentations 87 29 rate is lower. In this study severe discordancy
severe discordancy was seen in 12.4%.
26 12.4
single fetal demise 15 5 Single fetal demise (5%): The prognosis for the
cord prolapse 3 1 surviving twin depends on the gestational age at
the time of the demise, thechorionicity, and the
congenital anomalies 3 1
length of time between the demise and delivery
conjoined twins 2 of the surviving twin. Risk of co twin demise,
stuck twin neurological abnormality and preterm delivery is
2
more in monochorionic twins when compared to
interlocked twin 2
dichorionic twins.
Postpartum hemorrhage (3%): it may occur due
Congenital malformations (1%): It may be due to
to stretching of the uterine muscle fibers to the
defects resulting from twinning, defects from
maximum. It can be prevented by aggressive use
vascular anastomoses, and defects as a result of
of oxytocic agents immediately after delivery of
crowding (Table 7).
the placenta which we follow routinely in our
hospital. The lower incidence of postpartum
Mode of delivery
hemorrhage may be related to the use of active
Vaginal delivery occurred in 165 cases, in that
management of labor [12].
spontaneous being 149, forceps being 3 and
induced 14. Caesarean delivery occurred in 135
The increased risks to maternal outcomes from
cases with elective LSCS being 42 and
multiple pregnancies, such as anemia,
emergency LSCS being 92 reported (Table - 1).
hypertensive disorders and caesarean delivery
The commonest indications for cesarian section
were consistent with previous findings (Table
in this study were malpresentation and
6).
pregnancy-induced hypertension, but the earlier
observed hypertension was cord prolapse [11].
Fetal complications
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Mahita Reddy A., Madhavi KSS., Niharica. A study on risk of twin pregnancy. IAIM, 2016; 3(10): 139-145.
High incidence of prematurity, LBW, birth perinatal mortality observed in this study in low
asphyxia, associated with delay in delivery of 2nd birth weight infants. Similar results are reported
twin and high incidence of malpresentations by Hatkar and Bhide [14]. Birth asphyxia and
contribute to high perinatal mortality. Perinatal hyperbilirubinemia were other neonatal
mortality rate in our study is 8.08%. PNMR is complications seen in our study. This was also
2.3% higher in the second twin when compared observed by Hatkar and Bhide [14]. All the
to the first. The increased rate of perinatal death complications were found to be more among the
observed in twin pregnancies may be explained triplets than in the twins. Other studies report the
by the increased rate of intra-uterine growth same.
restrictions, premature rupture of membranes
among the twin deliveries [7, 9, 10]. The higher
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Mahita Reddy A., Madhavi KSS., Niharica. A study on risk of twin pregnancy. IAIM, 2016; 3(10): 139-145.
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