Complications of Twin Pregnancy

Objectives: To find out the maternal and fetal complications of twin gestation and to assess the effect of these complications on perinatal outcome. Material and Methods: This Descriptive study was carried out in Gynae B Unit of Khyber Teaching Hospital, Peshawar from January 2010 to December 2010. A total of 50 patients with twin pregnancy who had completed 28 weeks of twin gestation both booked and emergency admissions were included in the study. Evaluation was done by detailed history and data was collected in a proforma. Antenatal, intrapartum and postnatal complications as well as perinatal mortality and morbidity were calculated. Results: Out of total of 3951 deliveries, 50 patients with twin gestation were included. 66% were unbooked and 34% were booked belonging to age group of 31-33 years. 68% were multiparous. 52% presented at 37 plus weeks of gestation. 50% were in labour, 32% with PIH, 20% with iron deficiency anemia,12% with preterm prelabor rupture of membranes, hyperemesis gravidarum 12%, polyhydramnios 8%, antepartum haemorrhage 8%. Fetal complications were prematurity in 50%, co-twin demise in 10%, intrauterine growth restriction 8%, congenital anomalies in 8%. Vaginal delivery occurred in 80% of patients, while 20% had caesarean section. Perinatal mortality rate (PNMR) in terms of gestational age and weight was 360/1000 births. PNMR at 24-28 weeks was 1000/1000, at 33-36 weeks was 521/1000 and was 191/1000 births at 37-40 weeks of gestation. PNMR was highest with birth weights of 1.5 kg i.e., 1000/1000 while it decreased as the birth weight increased i.e. 131/1000 at birth weight of more than 2.5 kg. Conclusion: Twin pregnancy is a high risk pregnancy and to decrease its maternal and fetal complications it must be diagnosed early, should receive antenatal care and care at delivery. Early hospitalization plays an important role of reducing these complications.