MATERNAL AND PERINATAL OUTCOME IN MULTIFOETAL GESTATION

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MATERNAL AND PERINATAL OUTCOME IN MULTIFOETAL GESTATION

Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 18

Abstract

BACKGROUND Recently, the rate of multiple-gestation pregnancies has grown over the last few decades due to increased use of in-vitro fertilisation and ovulation induction techniques. Multiple pregnancy is considered as high risk due to associated high maternal morbidity and perinatal mortality in comparison with singleton pregnancies. Multiple pregnancies pose a number of unique challenges such as discordant growth abnormalities, intrauterine demise, preterm premature rupture of membranes or premature delivery of one or both twins. All adverse outcomes of pregnancy including mortality are more likely in multiples compared with singleton pregnancies, and associated risks increase in higher order multiples. Hence, this study was done to study maternal and perinatal outcome in multifoetal gestation. MATERIALS AND METHODS The study was carried out in the Department of Obstetrics and Gynaecology, Mahatma Gandhi Memorial Medical College and Maharaja Yashwant Rao Hospital, Indore from January 2013 to December 2013. This is a case series, which comprises a total of 142 cases of multiple foetal pregnancies. All multifoetal pregnancy with gestational age of more than 20 weeks were included in the study, either twins, triplets or quadruplets. The cases with singleton pregnancy or twins with foetal reduction were excluded in the study. RESULTS Incidence of multifoetal gestation was about 1.38%. Most (88%) of the patients were in the age group of 20 - 30 yrs. Correlation with ovulation induction was found in 15.5% of the patients. 78.87% were dichorionic-diamniotic, 13.38% were monochorionicdiamniotic and 4.9% were monochorionic-monoamniotic. Incidence of moderate PIH was 14.08% and severe PIH was 10.56% in multifoetal pregnancies in our study. Three patients (2.11%) had eclampsia and 18 (12.67%) were pre-eclamptic. Incidence of severe anaemia (haemoglobin < 7 gm%) was 4.92%, moderate anaemia (haemoglobin 7 - 9 gm%) was 19.71%, mild anaemia (haemoglobin 9 – 11 gm%) was 50% in our study. In our study, the distribution of presentation of first and second twins were as follows: 54.93% were cephalic-cephalic, 13.38% were cephalic-breech, 11.97% were breech-cephalic, 12.68% were breech-breech and 7.04% were presentation other than mentioned above. The incidence of caesarean section being 30.28% for first and 31.69% for second twin. 60.56% of first and 52.11% of second twin had cephalic vaginal delivery and 9.15% and 15.49% of first and second twin respectively had assisted breech delivery. 3 patients required section for second foetuses for obstructed labour after delivery of first foetus. In our study 4.22% delivered at less than 28 weeks of gestation, 19.72% delivered between 28 and 34 weeks, 19.01% were in gestational age from 34 to 37 weeks and 37.30% were 37 weeks or more. Total preterm birth rate being 51% (less than 37 weeks). The incidence of PROM is 13.38%. Low birth weight and low APGAR score were more common in higher order births as all 4 foetuses in quadruplets required NICU admissions, while most of foetuses born out of triplets were underweight. In our study, 40.14% of first and 44.37% of second twin had an APGAR score of less than seven at one minute and 13.38% of first and 23.94% of second foetus had an APGAR score of less than seven at five minutes (including stillbirths). 15.22% of first and 17.65% of second foetus required admission to NICU. Total incidence of NICU admissions among multifoetal gestation in our study is 33.9%. In our study 6.34% of first, 13.38% of second, 25% of third foetuses were stillborn. Incidence of PPH (7.04%) is high, but could be prevented with active alert and vigorous management. The incidence of APH in our study was 3.52%. CONCLUSION In mothers, there is increased risk of hypertension anaemia. They are more prone to malpresentation and increased rate of caesarean sections. Women with multifoetal gestation are more prone to PPH and PROM. Since women with more than one foetus deliver at early gestational age, babies born are preterm and low birth weight, low APGAR require more admissions to NICU.

Authors and Affiliations

Sonal Jain, Vaishali Jain, Laxmi Maru

Keywords

EP ID EP418127
DOI 10.14260/jemds/2018/512
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