Perinatal Outcome of Twin Pregnancies Compared based on Chorionicity and Antenatal Booking Status of Mother

Abstract

Introduction: Twin pregnancy is considered a high risk pregnancy due to multiple maternal and foetal complications leading to adverse maternal and foetal outcome. Aim: This study was planned to know foetal outcome of twin pregnancy according to chorionicity and also tried to observe difference in outcome among foetuses born to booked patients at our institute and foetuses those were born to referred patients. Materials and Methods: A retrospective study of four years pertaining to twin foetuses was carried out at tertiary hospital. Foetal data was collected from the individual mother’s file from antenatal period till the time of birth. Foetal outcome was analysed according to chorionicity of placenta and data of whole study population was further stratified into those (298) born to booked patients (minimum 4 antenatal visits) and those (564) referred to our institute. Discrete categorical data were presented as n (%); continuous data were given as mean±SD and range. Means of different parameters for three groups Diamniotic Dichorionic (DADC), Diamniotic Monochorionic (DAMC), Monoamniotic Monochorionic (MAMC) were compared using One-Way ANOVA followed by Post-Hoc Multiple Comparisons test. Proportions were compared between the referred and booked groups using the chi-square test. Results: Incidence of twin pregnancies was 22/1000 birth and 65% of them were born to referred patients. Out of 862 twin foetuses, 258 pair (59.8%) were Diamniotic Dichorionic (DADC), 162 (37.5%) were Diamniotic Monochorionic (DAMC) and 11 (2.5%) were Monoamniotic Monochorionic (MAMC) twins. Seventy percent of them were preterm delivered. In relation to chorionicity there was no difference in gestational age (34.9 weeks), however birth weight was significantly different (1.97±0.42 kg, 1.783±0.54 kg, 1.645±0.57 kg in DADC, DAMC and MAMC group respectively, p<0.001). Gross foetal malformations were observed in 8/862 (0.9%) of twins. The discordant twins were observed in 8.9% of foetuses. The incidence of intrauterine foetal death was 35/862 (4.0%), (nine in DADC, 20 in MCDA and 6 in MAMC group (p<0.001). There was significant difference in gestational age, birth weight, discordant twin, intrauterine foetal death and Apgar score among referred and booked patients (p<0.05). Conclusion: This study revealed importance of specialised antenatal care in reducing foetal mortality in utero and emphasise us to increase the availability of more number of intensive care units to enhance the survival rate of these premature foetuses after birth to decrease perinatal mortality and morbidity

Keywords

• acardiac twins
• discordant twins
• multiple pregnancy