Prevalence of twin deliveries and perinatal outcomes in public hospitals in Dar es Salaam

Abstract

Background Twin fetuses commonly result from fertilization of two separate ova while about one third of twins arise from a single fertilized ovum that subsequently divides into two similar structures. The occurrence and frequency of twinning varies across human populations. The perinatal mortality rates are five times higher in twin pregnancies than singleton pregnancies, therefore antenatal management and safe delivery of twin pregnancies are important issues in obstetrics. Reduction of perinatal mortality rate requires identification of causes and determinants of neonatal deaths and stillbirths, with subsequent strategies to tackle them. Objectives This study aimed at providing data on the proportion of twin deliveries in four public hospitals in Dar es Salaam and an insight on the fetal outcomes in relation to their modes of delivery. Methodology This was a cross sectional study in which all women who delivered twin babies were interviewed andmedical records on their delivery summary wereobtained in the labour or post natal wards atMuhimbili National Hospital, Temeke, Mwananyamala and Amanaminicipal hospitals in Dar es Salaam between July and December 2011. A structured Swahili questionnaire was used during the initial interview and post natal follow up was done on seventh day by contacting women by telephone to establish the neonatal status. Results There were 33638 total deliveries of which 672 were twin deliveries making the prevalence of 2.0% (20 per 1,000 births).Of all twin deliveries analyzed (666), 373(56.0%) had the diagnosis of twin pregnancy made antenatally and only 124(18.6%) had their mode of delivery planned.Vaginal delivery was the major mode vii of delivery accounting for 77.3% of all twin deliveries, whereas combined delivery in which the first twin was deliveredvaginally and the second twin by caesarian section accounted for only 2.6%. Three quarters (76.2%) of all caesarian sections in twin deliveries were done on emergency basis as compared to 23.8% which were planned.A total 1332 babies were delivered from 666 pairs, at birth1252(94%) were alive, 60(4.5%)were fresh stillbirths and 20(1.5%) were macerated stillbirths.Low Apgar score was more to first twins 76(14.5%) delivered vaginally compared to first twins 5(3.5%) delivered by caesarian section and this difference was statistically significant (p-value=0.003). Also more second twins 116(22.2%) delivery vaginally had low Apgar score compared to second twins 11(7.7%) delivered by caesarian section and this difference was statistically difference (p-value=0.001). Second twins delivered vaginally at 30 minutes or longerecond twins delivered vaginally at 30 minutes or longerecond twins delivered vaginally at 30 minutes or longer econd twins delivered vaginally at 30 minutes or longer econd twins delivered vaginally at 30 minutes or longerecond twins delivered vaginally at 30 minutes or longer econd twins delivered vaginally at 30 minutes or longer econd twins delivered vaginally at 30 minutes or longer econd twins delivered vaginally at 30 minutes or longer econd twins delivered vaginally at 30 minutes or longer econd twins delivered vaginally at 30 minutes or longer econd twins delivered vaginally at 30 minutes or longerecond twins delivered vaginally at 30 minutes or longer econd twins delivered vaginally at 30 minutes or longerecond twins delivered vaginally at 30 minutes or longer econd twins delivered vaginally at 30 minutes or longerecond twins delivered vaginally at 30 minutes or longerecond twins delivered vaginally at 30 minutes or longerecond twins delivered vaginally at 30 minutes or longer econd twins delivered vaginally at 30 minutes or longer econd twins delivered vaginally at 30 minutes or longer econd twins delivered vaginally at 30 minutes or longer econd twins delivered vaginally at 30 minutes or longer econd twins delivered vaginally at 30 minutes or longerecond twins delivered vaginally at 30 minutes or longer econd twins delivered vaginally at 30 minutes or longerecond twins delivered vaginally at 30 minutes or longer 27(48.2%) had low Apgar 27(48.2%) had low Apgar 27(48.2%) had low Apgar 27(48.2%) had low Apgar 27(48.2%) had low Apgar 27(48.2%) had low Apgar 27(48.2%) had low Apgar 27(48.2%) had low Apgar 27(48.2%) had low Apgar 27(48.2%) had low Apgar score score score compared to twins decompared to twins de compared to twins decompared to twins decompared to twins decompared to twins de compared to twins de compared to twins decompared to twins de livered in less than 30 minutes 72(15 livered in less than 30 minutes 72(15 livered in less than 30 minutes 72(15 livered in less than 30 minutes 72(15 livered in less than 30 minutes 72(15 livered in less than 30 minutes 72(15 livered in less than 30 minutes 72(15 livered in less than 30 minutes 72(15livered in less than 30 minutes 72(15 livered in less than 30 minutes 72(15livered in less than 30 minutes 72(15 livered in less than 30 minutes 72(15 livered in less than 30 minutes 72(15 livered in less than 30 minutes 72(15 -4%) and this was and this was and this was and this was and this was and this was and this was statistically significant both at one minute and fi statistically significant both at one minute and fi statistically significant both at one minute and fistatistically significant both at one minute and fistatistically significant both at one minute and fi statistically significant both at one minute and fistatistically significant both at one minute and fi statistically significant both at one minute and fi statistically significant both at one minute and fistatistically significant both at one minute and fi statistically significant both at one minute and fi statistically significant both at one minute and fi statistically significant both at one minute and fi statistically significant both at one minute and fi ve minutes ( pve minutes ( pve minutes ( p ve minutes ( p ve minutes ( p -value<0.0001). value<0.0001). value<0.0001).value<0.0001). value<0.0001). Conclusion Twin deliveries in four public hospitals in Dar es Salaam contribute to about 2.0% of all deliveries, with MNH having the highest proportion. Majority are delivered vaginally; while for those who delivered by caesarian section, the operation was largely done on emergency basis.There was a significant association between vaginal delivery and low Apgar score at one minute. Long duration of twin to twin delivery interval wasassociated with low apgar score of the second twins delivered vaginally. Perinatal mortality rate was also higher in the second twins compared to the first twins. Recommendations Formulation of protocols or guidelines on the antenatal and intrapartum management of twin pregnancyin the four hospitals is needed in order to improve the perinatal outcomes. The time delivery interval of the second twin should be made as short as possible by active management of all second twins.