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. 2013 Aug 1;8(8):e70549.
doi: 10.1371/journal.pone.0070549. Print 2013.

Maternal and perinatal outcomes of twin pregnancy in 23 low- and middle-income countries

Joshua P Vogel  1 , Maria Regina Torloni, Armando Seuc, Ana Pilar Betrán, Mariana Widmer, João Paulo Souza, Mario Merialdi
Affiliations

Maternal and perinatal outcomes of twin pregnancy in 23 low- and middle-income countries

Joshua P Vogel et al. PLoS One. .

Abstract

Background: Twin pregnancies in low- and middle-income countries (LMICs) pose a high risk to mothers and newborns due to inherent biological risks and scarcity of health resources. We conducted a secondary analysis of the WHO Global Survey dataset to analyze maternal and perinatal outcomes in twin pregnancies and factors associated with perinatal morbidity and mortality in twins.

Methods: We examined maternal and neonatal characteristics in twin deliveries in 23 LMICs and conducted multi-level logistic regression to determine the association between twins and adverse maternal and perinatal outcomes.

Results: 279,425 mothers gave birth to 276,187 (98.8%) singletons and 6,476 (1.2%) twins. Odds of severe adverse maternal outcomes (death, blood transfusion, ICU admission or hysterectomy) (AOR 1.85, 95% CI 1.60-2.14) and perinatal mortality (AOR 2.46, 95% CI 1.40-4.35) in twin pregnancies were higher, however early neonatal death (AOR 2.50, 95% CI 0.95-6.62) and stillbirth (AOR 1.22, 95% CI 0.58-2.57) did not reach significance. Amongst twins alone, maternal age <18, poor education and antenatal care, nulliparity, vaginal bleeding, non-cephalic presentations, birth weight discordance >15%, born second, preterm birth and low birthweight were associated with perinatal mortality. Marriage and caesarean section were protective.

Conclusions: Twin pregnancy is a significant risk factor for maternal and perinatal morbidity and mortality in low-resource settings; maternal risk and access to safe caesarean section may determine safest mode of delivery in LMICs. Improving obstetric care in twin pregnancies, particularly timely access to safe caesarean section, is required to reduce risk to mother and baby.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

References

    1. World Health Organization, UNiCEF, UNFPA, World Bank (2012) Trends in Maternal Mortality: 1990 to 2010. World Health Organization.
    1. UNiCEF, World Health Organization, World Bank, United Nations (2012) Levels and Trends in Child Mortality Report 2012. UNICEF.
    1. Smits J, Monden C (2011) Twinning across the Developing World. Plos One 6: e25239 doi:10.1371/journal.pone.0025239 - DOI - PMC - PubMed
    1. Sumathipala A, Siribaddana S, De Silva N, Fernando D, Abeysingha N, et al. (2002) Sri Lankan twin registry. Twin Res 5: 424–426. - PubMed
    1. Aisien A, Olarewaju R (2000) Twins in Jos Nigeria: a seven-year retrospective study. Med Sci Monit 6: 945–50. - PubMed

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