Outcomes of multiple pregnancies: results of a perinatology clinic in a tertiary health center

Yıl 2023, , 561 - 565, 31.05.2023

Barış Sever , Atalay Ekin

https://doi.org/10.32322/jhsm.1262414

Öz

Aim: To evaluate maternal-fetal risks and pregnancy outcomes in multiple pregnancies.
Material and Method: The study included 226 patients with multiple pregnancies who applied to the Perinatology clinic of Izmir Tepecik Training and Research Hospital between January/2020 and December/2022. The data of the patients were recorded and evaluated retrospectively using the hospital database.
Results: Of 226 patients, 211 were twins, 14 were triplets and one was quadruplet. Pregnancy occurred after in vitro fertilization (IVF) in 116 patients and after donation in 1 patient. 55.7% of the patients were older than 35 years. While 137 pregnants (60.6%) were primiparous, 89 patients (39.3%) had a previous pregnancy. While 20 of the twin pregnancies delivered before the 25th gestational week, this number was found to be 7 for triplets. 202 (89.3%) of all multiple pregnant women were delivered by cesarean section. Hypertensive disorder was found in 28 of the twin pregnancies and in 4 of the triplet pregnancies. Gestational diabetes was observed in 41 twin and 3 triplet pregnancies. Small for gestational age (SGA) was observed in 121 twins, 13 triplets and 1 quadruplet pregnancy. Intrauterine growth retardation (IUGR) was observed in 76 twins and 6 triplets. The number of multiple pregnancies with a birth weight less than 2500 g was found to 187 (82.7%) in total. Major congenital anomalies of various organs (cardiac, central nervous system, etc.) were observed in 8 (3.5%) pregnant women.
Conclusion: Preterm birth, increased maternal morbidity and increased cesarean section frequency are some of the risks of multiple pregnancies. These risks can be reduced by knowing the potential risks of multiple pregnancies and by more careful follow-up starting from the early stages of pregnancy.

Anahtar Kelimeler

Pregnancy, multiple, pregnancy complications, premature birth, pregnancy outcome

Kaynakça

• Smits J, Monden C. Twinning across the Developing World. PLoS One 2011; 6: e25239.
• Martin JA, Hamilton BE, Osterman MJK. Births in the United States, 2018. NCHS Data Brief 2019; 346: 1-8.
• Blondel B, Coulm B, Bonnet C, Goffinet F, Le Ray C; National Coordination Group of the National Perinatal Surveys. Trends in perinatal health in metropolitan France from 1995 to 2016: Results from the French National Perinatal Surveys. J Gynecol Obstet Hum Reprod 2017; 46: 701-13.
• Martin JA, Hamilton BE, Osterman MJ. Three decades of twin births in the United States, 1980-2009. NCHS Data Brief 2012; 80: 1-8.
• Esteves AP, Cunha A, Nakamura M, et al. Twin pregnancy and perinatal outcomes: Data from 'Birth in Brazil Study'. PLoS One 2021; 16: e0245152.
• Site name: Tuik Veri Portalı, URL address: https://data.tuik.gov.tr/Bulten/Index?p= Dogum-Istatistikleri-2020-37229. Access date: 20/01/2023
• Bellizzi S, Sobel H, Betran AP, Temmerman M. Early neonatal mortality in twin pregnancy: Findings from 60 low- and middle-income countries. J Glob Health 2018; 8: 010404.
• Smith GC, Fleming KM, White IR. Birth order of twins and risk of perinatal death related to delivery in England, Northern Ireland, and Wales, 1994–2003: retrospective cohort study. BMJ 2007; 334: 576.
• Santana DS, Cecatti JG, Surita FG, et al. WHO Multicountry Survey on Maternal and Newborn Health Research Network. Twin Pregnancy and Severe Maternal Outcomes: The World Health Organization Multicountry Survey on Maternal and Newborn Health. Obstet Gynecol 2016; 127: 631-641.
• Kulkarni AD, Jamieson DJ, Jones HW Jr, et al. Fertility treatments and multiple births in the United States. N Engl J Med 2013; 369: 2218-25.
• Adashi EY. Seeing double: a nation of twins from sea to shining sea. Am J Obstet Gynecol 2016; 214: 311–3.
• Dodd JM, Crowther CA. Specialised antenatal clinics for women with a multiple pregnancy for improving maternal and infant outcomes. Cochrane Database Syst Rev 2012; 15: CD005300.
• Cheong-See F, Schuit E, Arroyo-Manzano D, et al. Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis. BMJ 2016; 354: i4353.
• Khalil A, Liu B. Controversies in the management of twin pregnancy. Ultrasound Obstet Gynecol 2021; 57: 888-902.
• Vogel JP, Holloway E, Cuesta C, Carroli G, Souza JP, Barrett J. Outcomes of non-vertex second twins, following vertex vaginal delivery of first twin: a secondary analysis of the WHO Global Survey on maternal and perinatal health. BMC Pregnancy Childbirth 2014; 14: 55.
• Schmitz T, Prunet C, Azria E, et al. Association Between Planned Cesarean Delivery and Neonatal Mortality and Morbidity in Twin Pregnancies. Obstet Gynecol. 2017; 129: 986-95.
• Morikawa M, Yamada T, Akaishi R, et al. Prevalence of hyperglycaemia in singleton versus twin pregnancy. Diabetes Metab Res Rev 2015; 31: 198-203.
• Bajagain R, Karki C, Mahato S, Saha R, Saha N. Multiple Pregnancy among Deliveries in a Tertiary Care Center: A Descriptive Cross-sectional Study. Journal of Nepal Medical Association 2022; 60: 927–930.
• American College of Obstetricians and Gynecologists Committee on Practice Bulletins-Obstetrics; Society for Maternal-Fetal Medicine; ACOG Joint Editorial Committee. ACOG Practice Bulletin #56: Multiple gestation: complicated twin, triplet, and high-order multifetal pregnancy. Obstet Gynecol 2004; 104: 869-83.
• Narang K, Szymanski LM. Multiple Gestations and Hypertensive Disorders of Pregnancy: What Do We Know?. Curr Hypertens Rep 2020; 23: 1.
• Ru Y, Pressman EK, Cooper EM, et al. Iron deficiency and anemia are prevalent in women with multiple gestations. Am J Clin Nutr 2016; 104: 1052-60.
• Piro E, Schierz IAM, Serra G, Puccio G, Giuffrè M, Corsello G. Growth patterns and associated risk factors of congenital malformations in twins. Ital J Pediatr 2020; 46: 73.