ADVERSE FETOMATERNAL OUTCOME IN TWIN PREGNANCY IN WOMEN OF ADVANCED AGE.

Abstract

Background; Twin pregnancies in low- and middle-income countries (LMICs) pose a high risk to mothers and newborns due to inherent biological risks and scarcity of health resources which translate into insufficient care during pregnancy and delivery.  Due to inherent biological factors, twin pregnancies have increased rates of obstetric and perinatal complications such as preeclampsia, post-partum haemorrhage and preterm birth, which are known risk factors for maternal and perinatal mortality. Objective; To determine the frequency of adverse fetomaternal outcome in twin pregnancy in women of advanced age. Material and methods: A total of 181 patients with dichorionic diamniotic twin pregnancy on ultrasound having gestational age more than 24 weeks were taken in this cross-sectional study. Demographic information of patients (name, age, weight) was taken. Informed consent was taken from each patient, ensuring confidentiality and fact that there is no risk involved to the patient while taking part in this study. An obstetrical ultrasonography was done to confirm twin pregnancy. Blood samples were taken from all patients for assessment of anemia. Patients were followed up until pregnancy outcome. Results; Mean age of these study cases was noted to be 34.35 ± 2.41 years. Mean gestational age of our study cases was 34.67 ± 2.25 weeks. Mean BMI of our study cases was noted to be 22.45 ± 1.67 kg/m² (with minimum BMI was 19.4 kg/m² and maximum BMI was 32 kg/m²) and obesity was present in 27 (14.9 %) of our study cases. Of these 181 study cases, 126 (69.6%) delivered vaginally while 55 (30.4%) had to undergo cesarean section delivery. Mean hemoglobin level was noted to 8.67 ± 1.40 g/dl while anemia was seen in 126 (69.6%) of these study cases. Preterm labor was observed in 144 (79.6%), abruptio placentae in 19 (10.5%) and low birth weight in 123 (68 %) of our study cases.

Conclusion; Twin pregnancy is associated with high risk of perinatal and pregnancy outcomes. There was higher frequency of anemia, cesarean section deliveries, preterm births and low birth weight babies in our study. There is a need for specialised prenatal care to reduce complications and adverse outcome in multiple pregnancies, and the need for ongoing social and medical care beyond the prenatal and perinatal periods to improve perinatal outcomes in these patients.

Keywords; Preterm labor, anemia, twin pregnancy.