Maternal determinants and fetal outcome of multifetal pregnancies in Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Abstract

Background: Multifetal pregnancies remain a challenge to both parents and clinicians. With the increasing application of assisted reproductive technology in infertility management, the incidence is likely to continue to rise.

Aim and Objective: To determine maternal characteristics of multifetal pregnancies, maternal and fetal outcomes, at the Ahmadu Bello University Teaching Hospital (ABUTH), Nigeria. Patients and Methods: A retrospective observational study of women who had multifetal pregnancy in ABUTH Zaria over a period of 5 years was conducted. Information regarding maternal determinants and fetal outcome was collated. The data were analyzed using SPSS version 20.0. Demographic variables were presented using tables and figures, while summaries were done using means, standard deviation, and percentages. Test of association was done using Chi‑square. P value <0.05 was considered statistically significant.

Results: The total number of deliveries during the study period was 9399 out of which 254 were twins and 2 were higher order multifetal pregnancies. Giving us a rate of 27/1000 multifetal deliveries, majority of the women were booked (91%) and the average number of antenatal visits was 7.4 ± 3.1. The mean maternal age was 29 ± 6 and the mean parity was 2.4 ± 2.2. The mean gestational age at delivery was 36.5 ± 2.2. History of ovulation induction was present in 33% and 57% gave a family history of twinning. The Yoruba ethnic group had the highest incidence with 42.7%. A total of 19% were admitted for various indications, the commonest indication was hypertensive disorders (18%), 64% of the women had preterm deliveries, and 7.5% of the women delivered before 34 weeks. The caesarean section (CS) rate was 39.7%. The commonest presentation was cephalic. There was statistical significant difference between presentation and mode of delivery X² = 31.579 and P= 0.000. The mean birth weight of T₁=2.3 ± 0.5, and that of T₂=2.7 ± 3, and 68.3% of T₁ compared to 60.2% of T₂ had weight <2.5 kg. There was statistically significant difference between the mean birth weight and Apgar score of the leading fetuses P = 0.009. Up to 92.6% of T₁ were delivered alive, compared to 84.6% of T₂ , Mean interbaby delivery interval between T₁ and T₂ was 11.7 minutes. Male:female ratio was 1:1.1. Atotal of 23% were admitted to neonatal intensive care unit and the commonest indication for admission was low birth weight(35%). The commonest causes of perinatal mortality were asphyxia and sepsis. Perinatal mortality was 114 per 1000 births and maternal mortality rate was 1,639/100,000 live births.

Conclusion: Parity, ethnicity, maternal age, ovulation induction, and family history were the major determinants of multifetal pregnancies. There was association between presentation and mode of delivery and also the birth weight and Apgar score of the leading twins. Our multifetal pregnancy rate and cesarean section rate were high, associated with high maternal and perinatal morbidity and mortality.

Key words: Indications; maternal mortality; multifetal pregnancy; perinatal mortality; rate; training.