Triplet pregnancies in a southeastern Nigerian Hospital: Before the artefacts set in

Abstract

Background: Triplet pregnancies, though uncommon, occur with much higher maternal discomfort, morbidities, mortalities and perinatal morbidity and mortality when compared to singleton pregnancies. It is a well‑known fact that the incidence of triplet pregnancies differ in different regions of the world and even in different parts of the same country and that they are increasing around the world due to assisted reproductive technologies. The incidence and outcome of naturally occurring triplet pregnancies has never been evaluated in our center for us to know and have a baseline to compare any increase brought about by assisted reproduction along with other factors, and hence, we conducted this study.

Materials and Methods: This is a retrospective study of all the cases of triplet pregnancies delivered in Mile Four Maternity Hospital, Abakaliki, Ebonyi state in southeast Nigeria from January 1995 to December 2005. The cases were from the antenatal, labour ward and theater registers, and relevant information were retrieved and analysed.

Results: There were 22 triplet pregnancies over the 10‑year period under review and 23126 deliveries, giving an incidence of triplet pregnancy of 0.1% or 1 triplet pregnancy in 1051 deliveries. Many of the women 10 (45.5%) were in the 31–35 years age group, and half (11) were grand multiparas. Half of the gestational ages at delivery 11 (50%) were 35–37 weeks. The major antenatal complication was preterm labour in 5 or 22.7% of the women or half (50%) of the complications that occurred in the women. Two or 9.1% of the women had preeclampsia, 1 each or 4.5% had prolonged rupture of membrane, polyhydramnious and anaemia. Majority of the women, 18 (81.8%) were delivered vaginally and 4 (18.2%) by caesarean section. The babies had a weight range of 0.6–3.4 kg, with an average weight of 1.73 kg. Sixty babies (90.9%) were born alive and 6 (9.1%) were dead, giving a perinatal mortality rate of 91 babies per 1000. Of the alive babies, 42 (63.6%) had good Apgar score of 8–10 in 1 minute and 7 (19.6%) Apgar score of 1–4.

Conclusion: Triplet pregnancies are rare and high risk pregnancies that are associated with many fetal and maternal complications that are of great importance to the parents, care giver, and the health system. Obstetricians must find ways to optimize the outcome of these pregnancies, especially now that the incidence is bound to increase due to assisted reproductive technologies.

Keywords: Antenatal complications; Ebonyi State; incidence; increased medical bill; perinatal mortality; triplet pregnancies