Twins in Jos Nigeria: a seven-year retrospective study

A retrospective analysis of twin pregnancy was carried out between 1st January 1992 and 31st December 1998 to determine the incidence, epidemiological variables perinatal and maternal outcome of twin pregnancy in the institution.

The case notes of the 413 twin pregnancy, 6 triplets and 1 quadruplet delivered during the period, and the labour records of all the deliveries were analyzed. Statistical analysis was with chi-squared test. The level of significance was set at 5%.

The incidence of twin pregnancy was 28/1000, triplet 0.4/1000 and quadruplet 0.07/1000. The age range of the twin mothers was 15-47 years with a mean of 28 +/- 5.4 years. The parity range was 0-14 years with a mean of 3.3 +/- 2.6. Rising maternal age and parity were associated with twinning rate. The mean fetal weight was 2.21 +/- 0.66 kg. There was no statistical significant difference in weight between the 1st and 2nd twins. Male babies however weighed heavier (p < 0.02) than the female infants. The incidence of low birth weight babies (< 2500 g) was 58.7% with a perinatal mortality rate of 278.4/1000. The perinatal outcome was worst for the very low birth weight babies (< 1500), 817.5/1000 8.5% of twin mothers had a retained 2nd twin. The perinatal outcome of the 27 unbooked mothers who delivered their 1st twin at home was (12) 44.4/1000, compared to the rate of 12.5/1000 (1) in 8 booked mothers, who delivered the 1st twin in the hospital. Among the 771 babies who were alive at the time of presentation in the labour ward, delivery by caesarean section had a better perinatal outcome (6.8%), compared to spontaneous vaginal delivery (13.1%) and assisted breech delivery (21.4%). The unbooked twin mothers had a perinatal mortality rate of 318.7/1000 compared to booked mothers 82.3/1000. The overall perinatal mortality rate was 186.4/1000. The clinical causes of death were prematurity 74.6%, retained 2nd twin 7.3%, antepartum haemorrhage 6.1%, severe pregnancy induced hypertension/eclampsia 3.0%, birth asphyxia 2.4%, congenital malformation 1.8%. The incidence of postpartum haemorrhage was 3% and there was no maternal mortality in the series. The institution will need to put in place adequate resuscitating facilities and manpower to manage the low birth weight infants so as to reduce the current high perinatal wastage.