MATERNAL AND PERINATAL OUTCOME IN TWIN PREGNANCIES

BACKGROUND AND OBJECTIVE Twin pregnancy is a high-risk pregnancy associated with high maternal and perinatal morbidity and mortality. This study is conducted for evaluation of obstetric and perinatal outcome in our hospital. MATERIAL AND METHODS This prospective study was conducted in Thoothukudi Medical College Hospital in Department of Obstetrics and Gynaecology between March 2014 to February 2016 over a period of two years in twin pregnancies with gestational age more than 30 weeks and outcomes were studied. RESULTS Incidence of twin pregnancy was 9.64 per 1000 live births. 96% of cases are booked and had regular antenatal checkups. Among them, 75.82% of pregnant women belonged to the age group of 20-29 years and 60.43% were multiparous and 39.56% were primiparous women. Even though there was no maternal mortality, pregnancy complications were significantly higher in twin pregnancies. Most common obstetric problems seen in our study are preterm labour (25.27%), nutritional anaemia (37.36%), preeclampsia (17.58%), and premature rupture of membranes (13.18%). The other complication noted were antepartum haemorrhage (4.39%) postpartum haemorrhage (9.89%), oligohydramnios (6.59%), polyhydramnios (2.19%), hyperemesis gravidarum (6.59%), gestational diabetes mellitus (1.09%). Only 13.18% of patients had no complications. More than one complication was seen in most of the patients. Most common presentation of the foetuses during delivery of twin babies was cephalic cephalic presentation followed by cephalic-breech and breech-cephalic. Caesarean delivery was the most common mode of delivery. Caesarean section rate was 70% in our study. Incidence of perinatal morbidity requiring admissions in Neonatal Care Unit was 62.08%. Major reasons are prematurity, low birth weight, respiratory distress. Among the twins delivered, 14.28% were very low birth weight and 64.83% were low birth weight babies. Only 20.87% were normal weight babies. Discordant growth in twins was observed only in 4.39% of cases. The perinatal mortality rate was 10.43% and the major causes of death are respiratory distress, pulmonary haemorrhage, disseminated intravascular coagulation, sepsis, which are the complications of prematurity. CONCLUSION Prematurity was the major issue in twin pregnancies. So, regular antenatal checkups, nutritious diet, adequate rest, maternal corticosteroids therapy, and short-term tocolytic therapy in cases of preterm labour and institutional delivery with good neonatal care unit set up will definitely improve the outcome in twin pregnancy.