scholarly journals Fetomaternal Outcome in Twin Pregnancies: A Retrospective Analysis from a Tertiary Care Centre

Author(s):  
Kamlesh Kumari ◽  
Minakshi Misra ◽  
Ambika Jhanwar ◽  
Asha Kumari

Introduction: Twin pregnancies are among the major challenges faced by obstetricians globally. Increased maternal and foetal morbidity is observed with an increase in the incidence of twin pregnancies. Due to elevated rates of complications, a larger number of caesarean sections are performed in twin pregnancies in comparison to singleton gestation. Aim: The study aimed to find out the incidence of twin pregnancy with associated maternal risk factors and foetal outcome in the study population. Materials and Methods: This retrospective observational study was carried out at JNU Hospital and Medical College, Jaipur for a period of 4 years from December 2015 to December 2019. A total of 70 mothers, who presented with twin pregnancy, were included in this study. Data were collected from hospital records regarding maternal age, parity, whether spontaneous or assisted conception, gestational age, pregestational Body Mass Index (BMI) and family history. Details of maternal and foetal complications that occurred during the antenatal period and labour as well as the mode of delivery were collected and analysed. Statistical significance was considered if the p-value was ≤0.05. Qualitative data were represented as rate and proportions, while quantitative data were represented as mean and standard deviation. Results: A total of 70 mothers with twin births, resulting in 140 babies during the 4 years study period were included. A total of 4240 deliveries overall during the study period, gave a twin pregnancy incidence rate of 16.5 in 1000 deliveries. Preterm labour (25.4%), anaemia (26.8%) and hypertension (22.5%) were common problems. The most common indication for caesarean delivery was foetal malpresentation (37.8%) The mean weight of the first twin was 2.12±0.35 kg while the mean weight of the second twin was 1.97±0.30 kg. Among foetal complications, Intrauterine Growth Restriction (IUGR) was seen in 11.4% and birth weight discordance in 21.4% of children. A low Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score was noted in 21.4% of babies, while 12.9% of babies died in the early neonatal period. Conclusion: Maternal complications during twin pregnancy were mainly preterm labour, diabetes, hypertension and anaemia. Caesarean section was the main mode of delivery in this study with significant association with hypertension and preterm labour. Foetal complications were in the majority related to IUGR. More vigilance during the antenatal period and labour is needed for proper selection of mode of delivery. Active foetal surveillance and intervention with appropriate neonatal care can improve fetomaternal outcome.

Author(s):  
Divya Gupta ◽  
Premlata Mital ◽  
Bhanwar Singh Meena ◽  
Devendra Benwal ◽  
. Saumya ◽  
...  

Background: Multiple pregnancy remains one of the highest risk situations for the mother, foetus and neonate despite recent advances in obstetrics, perinatal and neonatal care. Twin pregnancies have increased rates of obstetric and perinatal complications compared to singletons Objective of present study was comparative assessment of fetomaternal outcome in twin pregnancy with singleton pregnancy in Obstetrics and Gynaecology Department of S.M.S. Medical College, Jaipur.Methods: This was a hospital based, prospective observational study done in the Department of Obstetrics and Gynaecology. S.M.S. Medical College, Jaipur from April 2015 to March 2016. 150 women with twin pregnancy and 150 women with singleton pregnancies at gestation age of 28 weeks and above coming for delivery and consented for the study were included in the study. Women with chronic medical disorder or chronic hypertension were excluded from the study. Maternal and neonatal outcome recorded and analysed.Results: Occurrence of twin in our study was 2.82%. Risk of preterm labour was about nine times higher in twin pregnancies than the singleton (OR: 2.74, 95% CI; 1.4494-5.1884, P value 0.001). The risk of premature rupture of membrane was increased by 2.74 times in twin pregnancies (OR:2.74; 95% CI: 1.4494-5.1884, p value .001). There was 3-time increased risk of malpresentation (OR 3.14; CI:1.7184-5.7480, p value .00002) and 2.28 times increase in hypertensive disorder (OR 2.28; 95% CI: 1.0727-4.8823, p value .03) in twin pregnancies. The risk of asphyxia and septicaemia was 2.5 times more in twins.Conclusions: Twin pregnancy is a high-risk pregnancy with more complications in mother and foetus and is a great challenge for obstetrician. So, it should be managed carefully at tertiary care centre to reduce the maternal and perinatal mortality and morbidity.


Folia Medica ◽  
2020 ◽  
Vol 62 (3) ◽  
pp. 468-476
Author(s):  
Samantha Mc Kenzie Stancu ◽  
Manuela Cristina Russu

Introduction: Appropriate intrapartum conduct in a twin delivery remains a challenging aspect of obstetric practice. The objective of this study was to compare neonatal and maternal outcomes in twin pregnancies according to mode of delivery.&nbsp; Materials and methods: This is a single centre retrospective cohort study of all consecutive spontaneously-conceived twin deliver-ies (&ge; 24 weeks, estimated fetal weight &ge; 500 grams) over a nine-year period between 01/01/2007 - 31/12/2016 at a tertiary-level centre. Neonatal outcomes included survival, APGAR score, prematurity-associated pathology (PAP), admission to the neonatal intensive care unit (NICU) and length of stay (LOS). Maternal outcomes included postpartum complications and LOS. Statistical analysis comprised Chi-square test with subsequent p-value and odds-ratio with 95% confidence interval. Statistical significance was set at p<0.05. Results: A total of 173 consecutive women with spontaneously-conceived twin deliveries were enrolled in this study, 129 (74.6%) women delivered by caesarean section (CS). The success rate of vaginal delivery (VD) was 93.6% (44/47). A strong statistical correlation was identified between CS and NICU admission; 53.2% vs. 1.5% (p=0.0001). Neonatal LOS in the NICU was significantly longer in the CS group. Prematurity-associated pathology (PAP) was noted in 75 pairs of twins (75/173); 61 pairs were delivered by CS, bearing strong statistical significance (p<0.0001). Postpartum complications occurred in 14.7% of CS compared to 13.6% of VDs.&nbsp; Conclusion: Neonates delivered by CS had a higher rate of PAP, NICU admission, lower birth weight and longer LOS. This study showed that VD is safe, especially when the first twin is in cephalic presentation


Author(s):  
Anand Karale ◽  
Kunaal K. Shinde ◽  
Hemant Damle

Background: An Intrauterine Fetal Demise (IUFD) is a major obstetrical catastrophe at any gestational age but the emotional pain and distress caused by this event increases in direct relation to the duration of pregnancy. The objective of the present study was to determine the incidence and possible causes of Intrauterine Fetal Demise (IUFD), and to determine preventive measures.Methods: Retrospective observational study was done from Jan 2015 to Dec 2017 at Smt. Kashibai Navale Medical College and General Hospital, Narhe, Pune. Inclusion criteria were all the pregnant women with IUFD delivered at the centre, at or above 24 weeks of gestation. The methodology followed were parameters of assessment for analysis were maternal age, parity, probable causes for IUFD, booked or unbooked cases, mode of delivery, maternal complications, and placental histopathology. Statistical data were analyzed using SPSS version 25.Results: The incidence of IUFD at authors’ hospital was 27/1000 live births. The IUFD rate was similar in maternal age <20years and >30years (p value 0.26). The incidence of IUFD increased with decreasing gestational age which was statistically significant (p value 0.001). IUFD incidence was higher in multiparous women compared to primiparous women (p value 0.036 with OR of 1.6 and 95% CI 1.02 to 2.54). The rate of IUFD was similar when sex of the baby was analyzed. 49.4% of fetuses had signs of maceration. The major cause of IUFD was severe preeclampsia (48.1%) which included HELLP syndrome, IUGR, Abruption. Maternal anemia (20.4%), GDM (3.8%), SLE (2.5%), APLA positive (2.5%), anhydramnios (6.3%) were some of the other important causes of IUFD.Conclusions: This study was conducted to determine the incidence of IUFD and associated maternal risk factors. By understanding the contributing factors, we can seek ways of avoiding recurrence of IUFD by proper antenatal care and early diagnosis of obstetric complications and its appropriate management.


Author(s):  
Rachel Mathew ◽  
Vinitha Wills ◽  
Jacob Abraham

Background: Study prevalence of twin pregnancy, maternal risk factors and fetal outcome in twin pregnancy.Methods: A retrospective study of mothers with twin pregnancies who delivered during the period of 5 years. There were 109 mothers who gave birth to 218 babies. Maternal details, antenatal complications and fetal outcomes were analysed.Results: There were 5432 deliveries which included 109 twin births. Prevalence of twinning was 20/1000 deliveries. The mean age was 28.11 (±SD 4.89) with 69.7% in the younger age groups. No association with parity, BMI and ovulation induction was found. Most common complication was preterm delivery (64.2%) with mean gestational age being 35.07 (±SD 2.32). Others were diabetes (25.7%), hypertension (22.9%), hypothyroidism (14.6%) and postpartum hemorrhage (13.7%). Cesarean section was the commonest mode of delivery (78.0%) with fetal malpresentation (26.6%), fetal distress (20.2%) and hypertension (12.0%) being the commonest indications for termination. Among the hypertensive mothers, 23 delivered by Cesarean and only 2 delivered vaginally which was statistically significant (p- 0.03 OR 5.20). Dichorionicity was commoner than monochorionicity (66.1% vs. 33.9%). Among 218 fetuses delivered, 214 were live births and 4 still born. There were low birth weight Babies (70.6%), normal weight (15.3%), VLBW babies (11.5%) and 2.7% ELBW babies. Fetal complications were IUGR (11.46%), discordant twins (6.8%), congenital anomalies (1.8%), single fetal demise (1.8%) and Intra uterine death of a twin (0.4%). Perinatal mortality rate was 1.65 per thousand births.Conclusions: Prevalence of twin pregnancy was 20/1000 deliveries. Twin pregnancies were seen to be more in the younger age group. Preterm labor, diabetes and hypertension were the main complications with cesarean the most common mode of delivery. Dichorionicity led to less fetal complications and low perinatal mortality.


Author(s):  
Bintu H. Dadhania ◽  
Shital T. Mehta ◽  
Pushpa A. Yadava ◽  
Bina M. Raval ◽  
Bhavi S. Shah ◽  
...  

Background: Fibroids are benign smooth muscle cell tumour of the uterus. In some patients of pregnancy associated with fibroid, it does not affect the outcome of pregnancy. On the other hand, various complications have been reported. The aim of our study was to evaluate the outcome in antenatal women with fibroids.Methods: This retrospective study was conducted at tertiary care center, obstetrics & gynecology department over a period of eighteen months between June 2018 to November 2019. Total 26 pregnant patients with >3 cm fibroid was included in the study. They were followed during antenatal period. Maternal age, parity, size of fibroid, complications during pregnancy, labour, and delivery, mode of delivery and indications of cesarean section were noted.Results: Out of 26 patients, 15 (57.6%) were between 26-30 years of age group and 16 (61.53%) were multigravidas. Normal vaginal delivery occurred in 8 (33.33%), while 16 (66.66%) delivered by caesarean section. There were 9 (34.61%) patients who had no complication whereas 17 (65.38%) had some complication. Pain was present in 8 (30.76%). PROM and preterm labour were present in 3 (18.75%) and 5 (19.23%) respectively. PPH was present in 2 (7.69%).Conclusions: Pregnant patients who have fibroids are to be carefully screened in the antenatal period, so as to have a regular follow up. The widespread use of ultrasonography has facilitated diagnosis and management of fibroids in pregnancy. The site and size of fibroid is very important to predict its effect on pregnancy.


Author(s):  
Nusrat Fozia Pathan ◽  
Shazia Jamali ◽  
Maqsood Ahmed Siddiqui ◽  
Khushi Muhammad Sohu ◽  
Ameer Ali Jamali ◽  
...  

Objective: To determine the perinatal outcome of twin pregnancy and to find out the frequency of twin deliveries in hospital based population. Study Design: Descriptive case series. Place and Duration of Study: The study was conducted over a period of 02 Year 1st January 2018 to 31st December 2019 in the Obstetrics and Gynaecology Department at KMC Khairpur Mirs, Sindh Pakistan. Methodology: All the patients of age 20-35 years with twin pregnancies of gestational age above 30 weeks presenting in labour ward of KMC Khairpur Mirs were studied. A detailed history was taken, general physical (G.P) examination and obstetrical examination performed, targeted investigations carried out to detect various fetal complications. Patients were assessed for a mode of delivery, records for data like age, gestational age, weight of baby, APGAR score expressed in term of mean±SD and data like perinatal mortality, prematurity, intra uterine growth restriction (IUGR), the weight of baby and APGAR score expressed in terms of frequencies and percentages on SPSS version 20. Results: In this study total numbers of deliveries were 7200, among them 83 were twin pregnancies the frequency of twin was 1.15%. Booked cases were 24.1%, unbooked was 75.9%. The highest incidence of 42.2% of twin gestation was seen in women between ages 31-35 years, the mean age of patients was seen 30.1±4.1 and regarding the parity incidence was high 54.2% in multiparous l-5. The total number of preterm deliveries was 45(55.2%), gestational age was (35-36+6dnys) weeks in 22.89% of cases, and the mean gestational age of patients was 35.7±2.5. Perinatal mortality was 38(22.9%), stillborn and early neonatal deaths (ENND) were 18.4% and 36.8% and common in twin-2. Conclusion: Twin pregnancy is-a-high-risk-pregnancy still is a major obstetrical and perinatal challenge. The frequency of twin pregnancy seen in this study is 1.15% unbooked and unsupervised pregnancies are more common i.e 75.9%.  Prematurity is common perinatal morbidity 51.20%.  perinatal mortality is 22.9% and highest in twin-2.


Author(s):  
Lekshmi Murukesan ◽  
Mayadevi Brahmanandan ◽  
Sujamol Sujamol Jacob

Background: Monochorionic twin pregnancies are at greater risk for growth abnormalities and other complications. This study aims to outline the obstetric problems faced by twins in general and also to determine the influence of chorionicity on pregnancy and perinatal outcome in twins. Objective of present study was to compare the obstetric and perinatal outcome between monochorionic and dichorionic twins.Methods: A clinical non-interventional prospective observational study was conducted in a tertiary care hospital over a period of 1 year. 232cases of twin pregnancies were followed up from first trimester. The antepartum complications, mode of delivery, presentation, pregnancy outcome, condition of babies and perinatal mortality were compared between mono-chorionic and dichorionic twins.Results: Among 232 cases of twins studied, 2/3rd were dichorionic and 1/3rd were monochorionic. The mean gestational age for Monochorionic (MC) twins was 33.2 weeks whereas it was 35.6 weeks for Dichorionic (DC) twins. Preterm delivery was significantly associated with mono-chorionicity. Elective CS was done more for MC twins compared to DC twins. The mean birth weight of MC twins was 1.7 kg compared to 2.1 kg among DC twins. Low APGAR scores were seen in 31.3% of MC twins compared to 15.8% of DC twins. The number of asphyxiated babies (12.5%), stillborn (7.5%) and macerated babies (10%) were more in MC group in comparison to DC group where it was (9.9%, 2.1%, 0.7%) respectively. Risk of IBN admissions were more in MC than DC twins. (31.3% Vs 21.1%) Adverse perinatal outcome was associated more with MC pregnancies (37.5%) than DC. (11.8%).Conclusions: Mono-chorioncity was significantly associated with pregnancy complications and adverse perinatal outcome. Hence early diagnosis of chorionicity and referral to a tertiary centre with fetal medicine unit and newborn care is very important in reducing morbidity and perinatal mortality among MC twins.


Author(s):  
Vaishali Chaudhary ◽  
Kamalpriya Thiyagarajan ◽  
Yogini Patil ◽  
Vijaykumar Gawali

Background: Twin pregnancies occurs in 2 to 4% of the total number of births. Also the perinatal mortality and morbidity associated with it is five to six times higher in comparison with singleton pregnancy. In developing countries, 287,000 annual maternal deaths and 3 million neonatal deaths contributes to 99% of such mortality as per records of the World Health Organization (WHO) estimates that 99% of the world's annual occur in developing countries.Methods: This observational study included 50 women with twin pregnancy with gestational age of 26 weeks or more. Maternal and neonatal characteristics in twin deliveries at a tertiary care center were analyzed. High risk factors and it’s association with maternal and perinatal outcomes was analyzed.Results: Pregnancy induced hypertension (32%) was the commonest, Preterm rupture of membranes (PROM, 22%) was in the next order. Invitro fertilization (44%), malpresentation (26%) main indicators for lower segment cesarean section. Mean weight of first twin was 1.9±0.43 kg and for second twin it was 1.89±0.47kg (Table 1). Most of twins were diamniotic dichorionic (78%).Conclusions: Twin pregnancies are hazardous to both for the mother and the neonate. It is certainly high risk factor which needs early identifications of complications and timely management. Perinatal outcome largely depends on gestational age, birth weight, presentation, mode of delivery.


Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Shuichi Hagiwara ◽  
Kiyohiro Oshima ◽  
Masato Murata ◽  
Makoto Aoki ◽  
Kei Hayashida ◽  
...  

Aim: To evaluate the priority of coronary angiography (CAG) and therapeutic hypothermia therapy (TH) after return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA). Patients and Methods: SOS-KANTO 2012 study is a prospective, multicenter (69 emergency hospitals) and observational study and includes 16,452 patients with OHCA. Among the cases with ROSC in that study, we intended for patients treated with both CAG and TH within 24 hours after arrival. Those patients were divided into two groups; patients in whom TH was firstly performed (TH group), and the others in whom CAG was firstly done (CAG group). We statistically compared the prognosis between the two groups. SPSS Statistics 22 (IBM, Tokyo, Japan) was used for the statistical analysis. Statistical significance was assumed to be present at a p value of less than 0.05. Result: 233 patients were applied in this study. There were 86 patients in the TH group (M/F: 74/12, mean age; 60.0±15.2 y/o) and 147 in the CAG group (M/F: 126/21, mean age: 63.4±11.1 y/o) respectively, and no significant differences were found in the mean age and M/F ratio between the two groups. The overall performance categories (OPC) one month after ROSC in the both groups were as follows; in the TH group, OPC1: 21 (24.4%), OPC2: 3 (3.5%), OPC3: 7 (8.1%), OPC4: 8 (9.3%), OPC5: 43 (50.0%), unknown: 4 (4.7%), and in the CAG group, OPC1: 38 (25.9%), OPC2: 13 (8.8%), OPC3: 15 (10.2%), OPC4: 18 (12.2%), OPC5: 57 (38.8%), unknown: 6 (4.1%). There were no significant differences in the prognosis one month after ROSC between the two groups. Conclusion: The results which of TH and CAG you give priority to over do not affect the prognosis in patients with OHCA.


2021 ◽  
pp. 48-50
Author(s):  
Ravindra S Pukale ◽  
Kavyashree H B

Introduction: Nutritional iron deciency is one of the most common deciency disorders affecting more than one billion people, with pregnant women at particular risk. In pregnancy iron decit attributable due to increased iron demand of the feto-placental unit and an increase in maternal red cell mass. 30% of anaemic women have haemoglobin levels below 10g/dl above 10% below 8g/dl. Irrespective of mode of delivery blood loss can also be a contributing factor postnatal. Oral iron therapy and intravenous iron sucrose are the main therapy of iron deciency anaemia. The present study is aimed at comparing both their efcacy side effects. METHOD : Aprospective randomised control study was done from June 2019- September 2020, in the department of Obstetrics and gynaecology, Adichunchanagiri Institute of Medical Science, BG nagara. 253 women including antenatal women between 8-38 weeks gestational age were studied and postnatal women studied with no associated obstetrics and medical complication. They were divided into Group A (Oral) and Group B(Intravenous) by randomization. The two groups were monitored clinically, and for an improvement in laboratory parameters after four weeks on day 30 haemoglobin and haematocrit were repeated in both the groups. This study results were expressed as mean +/- standard deviation. And to test the signicance of difference between Oral and IVmode of treatment, student Ttest was done to verify the statistical signicance. RESULTS: Out of 253 patients in the study the mean age of ANC patients was 24.7+/- 4.4years. Mean age of PNC patients was 24.15+/- 3.5years. The peripheral smear showed Dimorphic anaemia in 9.1% and Microcytic Hypochromic picture in 90.9 % of the patients. Initial haemoglobin of ANC patients was 9.8+/- 0.3g/dl. The initial haemoglobin of PNC patients was 9.73+/- 0.91g/dl. 59.3% of the patient had a haemoglobin between 7.1 and 10.0g/dl. Final haemoglobin of an ANC patient was 11.68+/-0.98g/dl, PNC patients 11.69+/-0.99g/dl. There was a substantial increase in Group Ahaemoglobin (oral iron) raising from 10.2+/-7.2g/dl to 12.0+/-0.92g/dl with a T value of 9.25. as well as in Group B (iron sucrose) raising from 9.3+/-8.5g/dl to 11.3+/-0g/dl with T value of 5.65. In both cases this raise in haemoglobin after four weeks had a p value less than 0.01 which was highly statistically signicant. Conclusion:Intravenous iron sucrose is more effective than oral iron for correction of anaemia with lesser side-effect


Sign in / Sign up

Export Citation Format

Share Document