An observational study of 100 cases of feto- maternal outcome of twin’s gestation

Abstract              Background: To study the fetomaternal outcome in twin gestation. it includes 1% of all pregnancies. Multiple birth are more common due to increase use of ovulation induction drug and other assisted reproductive technologies for infertility. However maternal and fetal. complications are more common than singleton pregnancies. Methods: The study was carried out in the department of obstetrics and gynecology, at PDU medical college and hospital, Rajkot, Gujarat from 1 October 2017 to 30 September 2018, a period of 1 year. All twins’ pregnancy admitted from antenatal clinic as booked cases or from labor room as emergency cases, above 28 weeks of duration of pregnancy was included in the study. During this period there were 7925 deliveries, out of which 118 cases were twins pregnancies. The study reviewed the outcome of 118 cases of twins pregnancy. Result: In this an observational studies we taken 100 cases of twins gestation. Twins gestation was found to be more common in 19-24 year of age. Most of them delivered below 37 weeks of gestation. The twins gestation was associated with increased maternal complications compared to singleton pregnancy (Preterm labor (79%). Majority of women delivered vaginally (68%) and (27%) by cesarean section LSCS Taken for malpresentation in most cases. The perinatal mortality was higher when delivered earlier than 33weeks of gestation. Prematurity was the outstanding cause of mortality. The perinatal mortality was occurred in 19 cases and among them prematurity was most common cause of death conclusion, Twins pregnancy is a high risk pregnancy and associated maternal and perinatal complications are high as compared to singleton pregnancy which are preventable by well set up obstetric high risk UNIT and NICU development.

Key Words: Twins pregnancy, preterm labour, low birth weight, perinatal morbidity.

INTRODUCTION

The phenomenon of twinning has fascinated mankind throughout its recorded history. Twins have often been regarded as being inherently different from singletons, and soci et al. responses to their birth have ranged from awe to fear¹. Twin foetuses commonly result from fertilization of two separate ova and are termed as double ovum, dizygotic or fraternal twins. About a third as often, twins arise from a single fertilized ovum that subsequently divides into two similar structures, each with the potential for developing into a separate individual. These twins are termed as single-ovum, monozygotic, or identical twins.² All dizygotic twins and one-third of monozygotic twins have separate inner and outer sacs and are thus dichorionic-diamniotic. Two thirds of monozygotic twins have a single outer sac and two inner sacs (monochorionicdiamniotic) and about 1% of twins will share their inner sac ie. monochorionic-monoamniotic.³ The incidence of twin pregnancies has increased remarkably since the late seventies because of the improved reproductive medicine and a greater proportion of older pregnant mothers who naturally have a higher incidence of multiple gestations.^4,5 The occurrence and frequency of twinning varies across human populations.⁶ The maternal age, socioenvironmental factors, increase in the use of contraceptives, the race of human population, 2 increase in spontaneous abortion rate and seasonal variations, are among the factors that could influence twinning rate.⁶ Twin pregnancies are more prone to complications than single pregnancies. Early in pregnancy there is high risk of miscarriage and sometimes one fetus dies and is reabsorbed resulting into the vanishing twin syndrome⁷. Other complications associated with twin pregnancy include high incidence of hypertension (pregnancy-induced hypertension, preeclampsia or eclampsia), gestationaldiabetes mellitus, bleeding in pregnancy (placenta praevia or abruptio), preterm birth and small-for-gestational-age babies due Intrauterine growth restriction (IUGR), postpartum hemorrhage, congenital malformations, and Twin to twin transfusion syndrome (TTTS)^3,7. Twin pregnancies in general population comprise about 1% of all pregnancies, but can account for up to 10% of perinatal mortality⁵. Low birth weight and prematurity are the main causes of high perinatal morbidity and mortality in twins, whereas malpresentation and the hazards of delivery are next in order of concern. For these reasons, twin pregnancy is considered a high-risk pregnancy; different aspects of the risk include the mode of delivery, which remains a subject of a controversy and discussion among obstetrician.

METHODOLOGY

Study is carried out at Department of Obstetrics and Gynecology, Zanana Hospital Rajkot, includes 100 Pregnant women who are admitted in Labour room with twin gestation from 1st October 2017 to 30th September 2018.

INCLUSION CRITERIA

• Women and their newborns who delivered vaginally and by caesarean section in our institution.
• Gestational age >28 week
• Women who give consent for this study.

EXCLUSION CRITERIA

•  Women who were delivered twins babies outside our hospital.
• Gestational age <28 Week.
• Woman who don’t give consent for this study.

Study is done during antenatal, intranatal and post-natal period till the patients are discharged.

Incidence of relevant factors, complications, characteristic of Twin gestations in antenatal period and the sequel of these complications on maternal and fetal outcome were analyzed. Detailed obstetrics history was taken. Family history of any twin gestation in maternal or paternal side was noted. History of intake of ovulation induction drugs and infertility treatment is taken. A general physical examination was done to note the associated complications like anemia, hypertension, and jaundice. Per abdomen examination was done to note the Uterine size, abdominal girth, presentation, presenting part, lie, position, amount of liquor, size and its relation to birth canal, uterine contraction and FHS were noted. Per vaginal examination was done to note cervical dilation, effacement, presenting part, status of the membranes and the adequacy of pelvis to rule out feto-pelvic disproportion. Progress of labour was monitored along with simultaneous feto-maternal monitoring. Adequate preparation was made to safely conduct the delivery of both twins and to safely resuscitate both the twins. Obstetrical outcome is recorded in terms of, Gestational age at the time of delivery, Parity of patient, Associated obstetric factor like PROM, Gestational hypertension, anemia etc, Mode of delivery: Vaginal/ Assisted vaginal delivery / Caesarean delivery, Type of placenta, if any other complications. Foetal outcome is recorded in terms of, Apgar Score at birth, Foetal Weight, NICU admission, Perinatal outcome, Neonatal mortality, if occurred cause of death.

RESULTS