V Uma^1*, S Nagamani², B Aruna³

¹Assistant Professor, ²Professor, ³Associate Professor, Department of Obstetrics & Gynaecology, MGMH Petlaburz Osmania Medical College, Koti, Hyderabad, INDIA.

Email: veludandiuma11966@gmail.com

RESULTS

During this period total deliveries -69,742 16,459 (2016); 16,999 (2017) 18,063(2018) 18,221(2019) during the study period. Out of them, 1245 were twin deliveries during study period of 4 years in which we have considered 311 twin deliveries. The incidence of twin pregnancy was found to be 1 in 56 pregnancies or 1.7% or 17 per 1000 births.

Table 1: Distribution of pregnant mothers with variable

Maximum number of women belonged to age group of 21-25 years (57%). The mean maternal age was 26.1 years. 52% of women were multipara. Family history of twins was found in 10% of women. The mean gestational age at delivery was found to be 35 weeks

Table 2: Pregnancy complications in present study

Pre-term labour resulting into preterm delivery was found to be the most common complication of twin pregnancy. 53.7% of women delivered before 37 completed weeks of gestation. Fetal malpresentation was found in 48.2%, maternal anaemia was the commonest medical complication (31.2%) in present study.

Table 3: Fetal presentations in present study

In present study, Cephalic-cephalic was the commonest presentation (41.8%) followed by cephalic –breech and breech –cephalic (18% each). Transverse-cephalic was the least common presentation. (0.6%).

Figure 1: Mode of delivery in present study

Caesarean sections are more in present study with 56%.

Most of the patients are with low birth weight (53%) followed by low APGAR score.

DISCUSSION

Multiple pregnancies are associated with significantly higher maternal and neonatal morbidity and mortality. Women pregnant with multiples are nearly six times more likely to be hospitalized during pregnancy, more than twice as likely to be admitted to the adult intensive care unit and to die compared with women with singleton pregnancies. Incidence in our study was be 1 in 56 pregnancies or 1.7% or 17 per 1000 births. Kamlesh Kumari et al.⁶ study twin pregnancies over 4 years shows the twinning rate to be 16.5/1000 deliveries. There is a wide variation in incidence rates among the world countries and the Indian subcontinent depending on the racial and geographical factors ranging from 6 to 18 per thousand .^7,8,9 This study incidence rate matches with the literature, though it is on the higher side of the range. This could be because the study represents a cross-section of high-risk pregnancies referred to this tertiary center with anticipated complications to mother and foetus. In our study Maximum number of women belonged to age group of 21-25 years (57%). The mean maternal age was 26.1 years. 52% of women were multipara. Family history of twins was found in 10% of women. The mean gestational age at delivery was found to be 35 weeks kamlesh Kumari et al. study majority were in the age between 21-30 years, with a mean age of 28.11±4.68 years. Almost similar mean maternal age of 28.3±4.05 years (range 20- 40 years) was observed from the study done by Jhaveri RR and Nadkarni TK at Nowrosjee Wadia Maternity Hospital .¹⁰ Lee YJ et al., in their analysis from Seoul, Korea showed the increased average age of twinning in mothers who had assisted contraception with average age of 32.0±1.4.¹¹ There is no difference seen in distribution of twin pregnancy cases according to primigravida and multigravida group. In our study Pre-term labour resulting into preterm delivery was found to be the most common complication of twin pregnancy which is nearer to that reported by other studies 62.5% by Pandey M.R.et al. and 53.8% by Ri-Na Su et al.^12,13 It is higher than reported (44%) by Sultana H. and Chowdhury S. et al. and quite lower than reported (84%) by Bangal et al.^14,15,16 In present study 53.7% of women delivered before 37 completed weeks of gestation which is similar to the mean gestational age reported by Muzhar et al. from Pakistan.17 There was no maternal mortality in this study. This was achieved by MULTIDISCPLINARY APPROACH- active management of 3^rd stage of labor, round the clock availability of blood products, anaesthetist and Maternal Intensive Care Unit. Present finding is consistent with the studies conducted by Masuda S and Sultana H who did not report any maternal mortality.^14,18In present study, Cephalic-cephalic was the commonest presentation (41.8%) followed by cephalic –breech and breech –cephalic (18% each). Upreti P.study showed 43.8% of twin pairs had cephalic-cephalic presentation, 19.3% cephalic-non- cephalic and 36.9% non-cephalic presentation of first twin. The corresponding figures by Masuda S et al. were 48% cephalic-cephalic presentation, 16% cephalic-non- cephalic and 36% non-cephalic first twin.¹⁸ In our study Casarean sections are more in present study with 56%. The corresponding figures reported by Pandey MR et al.¹² were 48% for the second twin.11 Present finding is comparable to the results reported by other studies such as 56% (Sultana H), 42% (Obiechina NJ et al.).^21,22 The higher caesarean section rate in present study was due to malpresentation of first twin, Preterm premature rupture of membranes, fetal distress and previous caesarean section. Most of the patients are with low birth weight (53%) Incidence of low birth weight was same as in present study similar to Ri-Na Su et al. from Bejing. (46.6%) 19 The low birth weight in twin deliveries is due to prematurity and intrauterine growth restriction caused by the pregnancy complications associated with twin pregnancy such as hypertension and anemia. Other fetal complications that were seen included neonatal asphyxia (low APGAR score), IUGR and birth weight discordance (4-5%). Perinatal mortality at 9.5% in present series, Kamlesh Kumari et al., study showed Perinatal mortality at 12.9% was less compared to other Indian studies.⁶ All cases were of early neonatal death. Variable rates of perinatal mortality (0.8- 2.6/1000 births) have been described in the literature.¹⁸ Fewer complications are seen in dichorionic than monochorionic twins. Good neonatal facilities(NICU) probably helped us to attain this good result.

CONCLUSION

Management of twin pregnancies is a challenging task for obstetricians. Twin pregnancy rates were more in the younger age group. Maternal complications during twin pregnancy were mainly preterm labour, diabetes, hypertension and anaemia. Caesarean section was the main mode of delivery in indicated cases in this study. Dichorionic gestations had less fetal complications and low perinatal mortality probably due to better biology. Fetal complications were in the majority related to intrauterine growth restriction. 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.

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