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. 2018 Nov 20;18(1):449.
doi: 10.1186/s12884-018-2082-9.

Perinatal outcomes in twin pregnancies complicated by maternal morbidity: evidence from the WHO Multicountry Survey on Maternal and Newborn Health

Danielly S Santana  1 , Carla Silveira  1 , Maria L Costa  1 , Renato T Souza  1 , Fernanda G Surita  1 , João P Souza  2 , Syeda Batool Mazhar  3 , Kapila Jayaratne  4 , Zahida Qureshi  5 , Maria H Sousa  6 , Joshua P Vogel  2 , José G Cecatti  7 ; WHO Multi-Country Survey on Maternal and Newborn Health Research Network
Affiliations

Perinatal outcomes in twin pregnancies complicated by maternal morbidity: evidence from the WHO Multicountry Survey on Maternal and Newborn Health

Danielly S Santana et al. BMC Pregnancy Childbirth. .

Abstract

Background: Twin pregnancy was associated with significantly higher rates of adverse neonatal and perinatal outcomes, especially for the second twin. In addition, the maternal complications (potentially life-threatening conditions-PLTC, maternal near miss-MNM, and maternal mortality-MM) are directly related to twin pregnancy and independently associated with adverse perinatal outcome. The objective of the preset study is to evaluate perinatal outcomes associated with twin pregnancies, stratified by severe maternal morbidity and order of birth.

Methods: Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS), a cross-sectional study implemented in 29 countries. Data from 8568 twin deliveries were compared with 308,127 singleton deliveries. The occurrence of adverse perinatal outcomes and maternal complications were assessed. Factors independently associated with adverse perinatal outcomes were reported with adjusted PR (Prevalence Ratio) and 95%CI.

Results: The occurrence of severe maternal morbidity and maternal death was significantly higher among twin compared to singleton pregnancies in all regions. Twin deliveries were associated with higher rates of preterm delivery (37.1%), Apgar scores less than 7 at 5th minute (7.8 and 10.1% respectively for first and second twins), low birth weight (53.2% for the first and 61.1% for the second twin), stillbirth (3.6% for the first and 5.7% for the second twin), early neonatal death (3.5% for the first and 5.2% for the second twin), admission to NICU (23.6% for the first and 29.3% for the second twin) and any adverse perinatal outcomes (67% for the first twin and 72.3% for the second). Outcomes were consistently worse for the second twin across all outcomes. Poisson multiple regression analysis identified several factors independently associated with an adverse perinatal outcome, including both maternal complications and twin pregnancy.

Conclusion: Twin pregnancy is significantly associated with severe maternal morbidity and with worse perinatal outcomes, especially for the second twin.

Keywords: Maternal morbidity; Perinatal outcome; Twin pregnancy.

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Conflict of interest statement

Ethics approval and consent to participate

The study protocol was approved by the WHO Ethical Review Committee and by relevant Institutional Review Boards in participating countries and institutions. The WHOMCS was a study of anonymized data, extracted from medical records (with no contact with women) and therefore individual consent was not required.

Consent for publication

Not applicable.

Competing interests

Prof. Fernanda G Surita is an Associate Editor of BMC Pregnancy and Childbirth. The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart of women in the analysis for adverse perinatal outcomes associated with twin pregnancy (each twin = one delivery)
Fig. 2
Fig. 2
Definitions of severe maternal complications according to the World Health Organization [14]. Portions reprinted from Say L, Souza JP, Pattinson RC; WHO working group on Maternal Mortality and Morbidity classifications. Maternal near miss—towards a standard tool for monitoring quality of maternal health care. Best Pract Res Clin Obstet Gynaecol 2009; 23:287–96, with permission from Elsevier. HELLP hemolysis, elevated liver enzymes, low platelet count, ICU intensive care unit, CPR cardiopulmonary resuscitation
Fig. 3
Fig. 3
Estimated risks (PRadj, 95% CI) of some adverse perinatal outcomes for the first and second twins comparatively with singletons, and second comparatively with first twins
See this image and copyright information in PMC

References

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