Twin deliveries in Sacred Heart Catholic Hospital Obudu: experience from a secondary health facility in South-South Nigeria

Abstract

Background: Twin pregnancy is associated with increased risk of obstetric complications as well as increased perinatal mortality rate. The study aims to determine the incidence and outcome of twin pregnancy in a rural/semi urban hospital which provide secondary level obstetric services in South- south Nigeria.

Method: This was a retrospective review of all twin deliveries at the Sacred Heart Hospital, Obudu.The case files of all patients who had twin deliveries from 1st January 2009 to 31st December 2014 were studied. The data extracted were age, parity; presentation of foetuses, mode of delivery, gestational age at delivery, maternal and foetal complications, Apgar score and foetal outcome. The data was analysed using IBM SPSS version 20 package. A p-value of < 0.05 was considered significant.

Results: The incidence of twin pregnancy was 1:32 deliveries. The mean age of the women was 27.0 +- 5.3 years. The highest incidence was among 25-29 years age group.The median parity was 2,range 0-7.About 78.1% (139) of the women were booked, while 21.9% were unbooked.Twin pregnancy was diagnosed before the onset of labour in 73.6% of the women.The mean gestational age at delivery was 37.1 +- 3.4 weeks, with 19.1% (34) delivered preterm.

Preterm delivery was the commonest complication (39.9%), followed by retained second twin. Abnormal presentation of the leading twin was the most common indication for Caesarean section (41.9%), followed by retained second twin (12.9%).About 66.8% of the patients had the leading twin in cephalic presentation, cephalic: cephalic presentation was the most common presentation (43.8%).The mean birthweight of the first twin was 2.4+-0.6kg and the second twins 2.3+-0.6kg. The first twin had fewer babies with 5-minute Apgar score less than 7 compared to the second,there were also more stillbirths among the second twins, P< 0.0001.The overall stillbirth rate was 112.7/1000 births compared with 63.1/1000 for all singleton deliveries in the centre.

Conclusion: Twin pregnancy is common in our secondary health facility and is associated with high maternal and foetal complications and stillbirth rate. More in-service training of doctors and midwives on skills of twin delivery and early decisions on referral for specialised care are recommended.

Keywords: Twin deliveries, secondary health facility, foetal outcome