Pregnancy outcome of women with twin gestation who delivered in Kenyatta National Hospital in 2015.

Abstract

INTRODUCTION: Twin pregnancies are considered high-risk pregnancies due to inherent biological factors that put the woman as well as the babies at increased risk. Despite only comprising about 2%, they contribute significantly to maternal and perinatal morbidity and mortality. This study will evaluate the outcomes of these high-risk pregnancies at the facility, it will therefore be important in improving care for twin pregnancies. OBJECTIVE: To determine the maternal and perinatal outcomes of women with twin pregnancies delivering at Kenyatta National Hospital. STUDY DESIGN: A hospital based Retrospective Descriptive Cross-sectional study. STUDY SETTING AND SITE: The study was conducted at the Department of Reproductive Health, KNH. STUDY POPULATION: The study population was women with a diagnosis of twin pregnancy who delivered at KNH from 1st January 2015 to 31st December 2015. SAMPLE SIZE: A total of 287 of women with twin pregnancies delivered at KNH during the study period. The sample size was calculated as 141, however a total 203 files with the prerequisite information were reviewed Outcome measures: Maternal: Pregnancy induced hypertension (PIH), Preterm labour and delivery, APH, PPH, C/S rates and maternal mortality. Perinatal outcomes: IUFD/ still births, Low birth weight, Apgar scores <7 at 5 minutes, admission to NBU/NICU. DATA COLLECTION: Data was collected using a structured abstraction form prepared by the principal investigator. DATA ANALYSIS: Data analysis was done via SPSS version 20. RESULTS Frequency of twin deliveries in KNH was 1 in 55 deliveries. Twinning in this study did not increase with age or parity. Majority of the patients were primigravida(31%). 80.8% of the cases the diagnosis was made during the antenatal period, 76% by obstetric ultrasound. 53.7% of the mothers delivered before 37 completed weeks. Most (80.5%) of the deliveries were cesarean sections. There was significant association between the mode of delivery and level of education OR 2.93(95% CI 1.10-7.84) p = 0.032. Chorionicity did not influence the mode of delivery p=0.11. The most common maternal complication was preterm delivery with 139(53.7%) delivering before 37 completed weeks. There were 52 (25.6%) mothers who had pregnancy induced hypertension, PROM was reported in 33 (16.3%) of mothers, anemia in 26 (12.8%) and PPH occurred in 25 (12.3%). Majority of the twins were live births 97.5% for the first twins and 91% for the second twins. Second twins were 5 times more likely to suffer mortality compared to first twins OR 5.33(95% CI 1.53-25.6) p= 0.003. The odds of mortality were approximately three times higher among second twins delivered through cesarean section (AOR = 3.67, 1.08-20.5) p=0.033. The remaining perinatal outcomes were not significantly associated with birth order: low APGAR (p = 0.179), NBU admission (p = 0.074). CONCLUSION Maternal outcomes and neonatal outcomes in this study were found to be comparable to similar studies elsewhere. The cesarean section rate for twins was found to be 80.5%, this was high compare to similar studies done elsewhere. Standardization of care for twin gestations at the facility may reduce the cesarean section rate.