Global Journal of Medical Research, E: Gynecology and Obstetrics, Volume 21 Issue 3

Table 3: Fetal outcome Fatal outcome Number Percentage Birth weight < 1 kg 1-1.5 kg 1.6-2.5 kg > 2.5 kg 6 19 77 18 5% 15.8% 64.1% 15% NICU Admission 72 60% RDS 42 35% IUGR 16 13.3% hyper-bilirubinaemia 12 10% Septicaemia 4 3.3% Perinatal mortality 18 15% APGAR < 7 at 1 min 76 63.3% APGAR > 7 at 10 min 80 66.6% IV. D iscussion Twin pregnancies are high risk pregnancies requiring special care and multidisciplinary approach towards their management. The incidence of twin pregnancy in our study was1.4%, the possible reasons for the rise in number are referral to our hospital for better neonatal care in anticipation of complications in neonates. It was observed that these women with twin pregnancies were regular in antenatal visits irrespective of distance from home or parity. It was also observed that incidence of anaemia, hyperemesis, gestational diabetes and pregnancy induced hypertension in twin pregnancy was significantly higher as compared to singleton pregnancies. Majority of the women in present study (70%) were aged between 20 -29 years. This is consistent to a study by Spellacy et al where 55% were aged between 20 -29 years. 5 Parity distribution of our study showed 63.3 % patients as multipara which is consistent to report by Spellacy et al where 84.2% patients were multipara. Conservative management with tocolytic drugs and steroid were administered prophylactically for prevention of preterm labour in 70% twin pregnancies. In the study many women were found to have had premature onset of labour resulting in premature babies. This observation is seen to have occurred in spite of precautions like adequate rest, prophylactic tocolytic administration and cerclage. The present study was compared to a study which was done among all twin pregnancies admitted in Institute of Post Graduate Medicine and Research, Dhaka now Bangabandhu Sheikh Mujib Medical University (booked and unbooked cases were considered for the study). 6 Among primis and multigravidas the incidence of twins was 36.6% & 63.3%. In the Chaudhary study it was reported that twins were more common in multis (64.2%) as compared to primis (35.8%). 6 Chaudhary et al reports an incidence of 44% preterm delivery among twin pregnancies. 6 The present study shows an incidence of 83.3%. Placentation was determined by antenatal ultrasonography and inspection of placenta and membranes after birth. Dichorionic placentation was seen in majority (60%) in our study, which is comparable with Erdemoglu et al (69.3%) and Panwala et al (63.8%). 7,8 Vertex –vertex (Vx-Vx) presentation at delivery was most common fetal presentation in present study (52%) and was to be consistent with another study by Chowdhury et al (47.5%) and Panwala et al (51.4%). 8,9 Most frequent mode of delivery in our study was by lower segment caesarean section (76.6%), consistent to studies by Chowdhury and Sultana (49.1% and 56% respectively). 9,10 Preterm labour was found to be the most common maternal complication in our study seen in 70% cases. Preterm delivery rate in our study was 70% and we found a high preterm caesarean section rate of 20% in present study. This finding is in contrast to previous studies by Chowdhury, Sultana and Papicrnik where preterm delivery rates were 41.5%, 44% and 50.7% respectively. 9,10,11 Higher preterm delivery rate in present study could be attributed to higher incidence of associated obstetric and /or medical co-morbidities in our patients, necessitating early delivery. Anaemia was the second most common maternal complication in our study reported in 60% patients in present study whereas the corresponding figures reported by Chowdhury and Brown et al were 35.8% and 35.5% for anaemia. 9,12 Hence authors reported higher incidence of anaemia in our study. However, a much higher incidence of anaemia was found by Bangal et al (84%). 13 Among the women with twin gestation under study it was found that 36 (6.%) had anaemia, 19 (31.6%) were diagnosed with hypertension and 4 (6.6%) had hydramnios as compared to 35.8%, 22.6% and 5.7%respectively as reported by Chaudhary et al. 6 The incidence of APH and PROM were 2 (3.3%) and 8(13.3%) whereas Chaudhary reports an incidence 5.7% of APH and 3.8% of PROM. 6 Birth hypoxia was reported in 35% of neonates. The incidence of birth asphyxia was much higher among second coming twins (55.5%) than first coming twins (24.5%). Hypertensive disorders (PIH/ Pre-eclampsia/ Eclampsia) were reported in 35% patients in present study. This is higher in comparison to that observed in 37 Year 2021 Global Journal of Medical Research Volume XXI Issue III Version I ( D ) E © 2021 Global Journals A Retrospective Study: Twin Pregnancy at Tertiary Care Centre, Maternal and Perinatal Outcome