Abstract

Background: Twin gestation are the major cause of perinatal and neonatal morbidity and it represents one of the principal targets for obstetric health care. Aim of this study is to identify etiological factors and to assess the outcome with twin gestation. Methods: The study conducted in WEST INDIA in a tertiary care center for a period of 5 year (January 2012 to December 2017). A total of approx 500 antenatal cases with twin gestation attending antenatal OPD in our hospital study.Antenatal USG scan done to document twin gestation and confirm type of twins gestation and gestational age. Maternal parameters (demographic and physiological) and fetal outcome (birth weight, NICU admission, etc) parameters documented and analysed using statistical methods. Results: Patients with twin gestation, more than 28 weeks of pregnancy, booked, emergency and referred cases are taken as inclusion criteria for patients. • Incidence of twin pregnancy in this study was 1.05%, Positive family history was found in 4% cases. Positive obstetric history of twins was found in 9.3% cases, In our study, 89% had conceived spontaneously, 9.7% after ovulation induction by clomiphene citrate and gonadotrophins, and 1.3% after IVF. Most of the patients were primiparous and second gravid (29%, 33.3%) and from low socio economic class (63%). 70.7% mothers developed preterm labour before 37 completed week. Antepartum, intrapartum and postpartum maternal and fetal complications were studied. Preterm labor was the commonest complication in our study. Incidence of preterm labor was 71%, preeclampsia 22% and anemia 27%. Antepartum haemorrhage was not seen in any patient. Post partum hemorrhage was seen in 2.7% cases. Pressure symptoms in form of breathlessness oedema feet was seen in 13% patients. Commonest presentation was vertexvertex 31% followed by breechbreech 27%. • In the present study a. Cephaliccephalic in 31% b. Cephalicbreech in 21% c. Breechbreech in 27% d. Breechcephalic in 20% • The majority of cases in this study had vaginal delivery (57%) and 39% had cesarean sections. 1.3% of first twin delivered by forceps. In vertex presentation incidence of LSCS was 13%. In breech presentation incidence of LSCS was 24%. The most common indication of cesarean section being non vertex presentation of the first baby followed by fetal distress. • Incidence of maternal morbidity >blood transfusion (26.6%) >breast engorgement (10.7%) >wound gap (6.7%) >decreased milk secretion (6.7%) >UTI (2.7%) >Puerperal infection (2.7%) • Neonatal morbidity was in form of RDS (30%), Jaundice (7%), Sepsis (2%), Hypoglycemic convulsion (3%), Asphyxia (3%). In the present study, 5.4% of first twin and 9.4% of second twin were less than 1500 grams; 81.3% of first twin and 77.3% of second twin were between 15002500 grams and 13.3% of first twin and 13.3% of second twin had a birth weight of >2500 grams. 1st twin with birth weight 11.5 kg neonatal mortality was 75% while for birth weight 1.52 kg it was 8%. 2nd twin with birth weight 11.5 kg neonatal mortality was 86% while for birth weight 1.52 kg it was 14%. In our study, 45.33% NICU admission was observed for prematurity, low birth weight, Respiratory Distress Syndrome, septicemia and hypoglycemia. Neonatal mortality was seen in 14.6% of cases, were prematurity, hyaline membrane disease, meconium stained liquor aspiration being the commonest cause of death.

Keywords: Twin Gestation; Etiology; Risk Factor. 

No records found.