Maternal and perinatal complications in multiple versus singleton pregnancies: a prospective two years study

To test the hypothesis that women with multiple gestations are at increased risk of adverse maternal and perinatal outcomes when compared with singletons.

From January 1999 to December 2000, all multiple pregnancies delivering > 28 weeks gestation in the labour ward of Mother and Child Health (MCH) Centre, Pakistan Institute of Medical Sciences (PIMS), Islamabad, were taken as cases. Singleton pregnancy > or = 28 weeks gestation period delivered immediately after each case was chosen as control. Prenatal complications, gestation at delivery, mode of delivery, birth weight and perinatal morbidity and mortality of the two groups were compared.

There were 6831 deliveries including 120 twins and 2 triplets. The data of the two triplets are presented separately and further comparison is between 120 twins and singleton controls. Pretem labour was the commonest prenatal complication in twin pregnancies (21 vs 62) followed by anaemia (11 Vs 39). The mean gestational age of singletons was 38.3 weeks compared to 35.9 weeks for twins. The mean birth weight of singletons was 2.9 kg vs 2.1 kg for twins. Six (4.9%) singletons and 46 (19.2%) twins had caesarean section. Thirty one (13%) of the twins and I (1.6%) singleton had vaginal breech delivery. Five (4%) singleton infants and 40 (17%) twins required admission. Ten singletons and 26 twins died perinatally resulting in a PNMR/1000 births of 82 and 108 respectively.

Women with multiple gestations are at a higher risk of antepartum and intrapartum complications and their infants require special care. There is need to identify these cases early in order to provide good prenatal care and deliver them in hospitals with facilities for neonatal and maternal intensive care.