Multiple pregnancy as a risk factor in rural Tanzania

Area of Science:

• Obstetrics and Gynecology
• Reproductive Health
• Perinatology

Background:

• Twin pregnancies are often assumed to have high rates across Africa.
• Hospital-based studies may overestimate prevalence due to selection bias.
• Population-based data is crucial for accurate twinning rate assessment.

Purpose of the Study:

• To determine the prevalence of twin pregnancies in rural Tanzanian hospitals.
• To analyze perinatal mortality rates in twin births within these settings.
• To evaluate the necessity of increased caesarean section use for twin births.

Main Methods:

• Retrospective analysis of twin birth data from two rural hospitals in Tanzania.
• Review of existing literature on African twinning rates, distinguishing hospital-based from population-based studies.
• Calculation of perinatal mortality rates based on birthweight.

Main Results:

• Twin pregnancy prevalence ranged from 15 to 20 per 1,000 births in the studied hospitals.
• Perinatal mortality for twin births was notably low (30-40 per 1,000 births), particularly for infants weighing at least 1,500g.
• A single population-based study in Nigeria reported a higher rate of 45 per 1,000 births.

Conclusions:

• The observed twinning rates in rural Tanzanian hospitals are within expected ranges, challenging assumptions of universally high African rates.
• Low perinatal mortality in twin births, especially with adequate birthweight, indicates effective current management.
• A more liberal approach to caesarean sections is not supported by these findings for further reducing twin perinatal mortality.