Maternal determinants and fetal outcome of twin pregnancy: a five-year survey


  • Rachel Mathew Department of Obstetrics and Gynecology, Pushpagiri Medical College, Thiruvalla, Kerala, India
  • Vinitha Wills Department of Obstetrics and Gynecology, Pushpagiri Medical College, Thiruvalla, Kerala, India
  • Jacob Abraham Department of Pediatrics and Neonatology, Pushpagiri Medical College, Thiruvalla, Kerala, India



Fetal outcome, Maternal risk factors, Twin pregnancy


Background: Study prevalence of twin pregnancy, maternal risk factors and fetal outcome in twin pregnancy.

Methods: A retrospective study of mothers with twin pregnancies who delivered during the period of 5 years. There were 109 mothers who gave birth to 218 babies. Maternal details, antenatal complications and fetal outcomes were analysed.

Results: There were 5432 deliveries which included 109 twin births. Prevalence of twinning was 20/1000 deliveries. The mean age was 28.11 (±SD 4.89) with 69.7% in the younger age groups. No association with parity, BMI and ovulation induction was found. Most common complication was preterm delivery (64.2%) with mean gestational age being 35.07 (±SD 2.32). Others were diabetes (25.7%), hypertension (22.9%), hypothyroidism (14.6%) and postpartum hemorrhage (13.7%). Cesarean section was the commonest mode of delivery (78.0%) with fetal malpresentation (26.6%), fetal distress (20.2%) and hypertension (12.0%) being the commonest indications for termination. Among the hypertensive mothers, 23 delivered by Cesarean and only 2 delivered vaginally which was statistically significant (p- 0.03 OR 5.20). Dichorionicity was commoner than monochorionicity (66.1% vs. 33.9%). Among 218 fetuses delivered, 214 were live births and 4 still born. There were low birth weight Babies (70.6%), normal weight (15.3%), VLBW babies (11.5%) and 2.7% ELBW babies. Fetal complications were IUGR (11.46%), discordant twins (6.8%), congenital anomalies (1.8%), single fetal demise (1.8%) and Intra uterine death of a twin (0.4%). Perinatal mortality rate was 1.65 per thousand births.

Conclusions: Prevalence of twin pregnancy was 20/1000 deliveries. Twin pregnancies were seen to be more in the younger age group. Preterm labor, diabetes and hypertension were the main complications with cesarean the most common mode of delivery. Dichorionicity led to less fetal complications and low perinatal mortality.


Cunningham GF, MacDonald PC, Gant NF, Levano KJ, Gilstrap LC. Multifetal Gestation. In: Williams Obstetrics. 24th ed. Norwalk GT: Appleton and Lange: Ch 45; 2014:891-925.

Seshadri L, Arjun G. Multifetal pregnancy. In: Katragada VD, Chauhan P., editors. Essentials of Obstetrics Wolter Kluwer 1st Ed; 2015;32:455-473.

Rao A, Sairam S, Shehata H. Obstetric complications of twin pregnancies. Best Pract Res Clin Obstet Gynecol. 2004;18:557-76.

Baxi A, Kaushal M. Outcome of twin pregnancies conceived after assisted reproductive techniques. J Hum Reprod Sci. 2008;1:25-8.

Kor-anantakul O, Suwanrath C, Suntharasaj T. Outcome of multifetal pregnancies. J Obstet Gynaecol Res. 2007;33:49-55.

Blondel B, Kaminski M. Trends in the occurrence, determinants and consequences of multiple births. Semin Perinatal. 2002;26:239-49.

Norwitz ER, Edusa V, Park JS. Maternal Physiology and complications of multiple pregnancy. Semin Perinatol. 2005;29:338-48.

Murukesan L, Brahmanandan M. Fetal complications in twin pregnancies with special reference to chorionicity. Academic Med J India. 2015;3(1):13-7.

Nwankwo TO, Aniebue UU, Ezenkwele E, Nwafor MI. Pregnancy outcome and factors affecting vaginal delivery of twins at University of Nigeria Teaching Hospital, Enugu. Niger J Clin Pract. 2013;16:490-5.

Akaba GO, Agida T E, Onafowokan O, Offiong RA, Adewole ND. Review of twin pregnancies in a tertiary hospital in Abuja, Nigeria. J Health Popul Nutr. 2013;31(2):272-7.

Satija M, Sharma S, Soni RK, Sachar RK, Singh GPI. Twinning and its Correlates; Community- Based study in a Rural Area of India. Bookcomp, Inc.-Wayne State University Press/ Page 611/ 1st proof/ Human Biology 80-6/ December 2008.

O’ Connell MP, Deo P, Lindow SW. Twin pregnancy in a tertiary referral unit- analysis of trends in the 1990s. J Obstet Gynecol. 2002;22(2):173-4.

Manlan G, Scott KE. Contribution of twin pregnancy to perinatal mortality and fetal growth retardation; reversal of growth retardation after birth. CMAJ. 1978;118:365-7.

Bassey G, Inimgba NM. Fetomaternal outcome of twin gestation in Port Harcourt, South- South, Nigeria. Niger J Med. 2014;23(4):282-7.

Dodd JM, Crowther CA, Haslam RR, Robinson JS. Elective birth at 37 weeks of gestation versus standard care for women with an uncomplicated twin pregnancy at term: the twins timing of birth randomised trial. BJOG. 2012;119(8):964-73.

Suzuki S. Obstetric Outcomes in Nulliparous women aged 35 and over with dichorionic twin pregnancy. Arch Gynecol Obstet. 2007;276:573-5.

Ratha C, Kaul A. An analysis of pregnancy outcome in dichorionic and monochorionic twins given special antenatal and intranatal care, a four year survey. J Obstet Gynaecol India. 2014;64(4):256-9.

Laskov L, Michaan N, Cohen A, Tsafir Z, Maslovitz S, Kupferminc M et al. Outcome of twin pregnancy in women ≥45 years old; a retrospective cohort study. J Matern Fetal Neonatal Med. 2013;26(7):669-72.

Dodd JM, Grievelle RM, Crawther CF. Multiple pregnancy. In: James DK, Steer PJ, Weiner CP, Gonik B. Eds. High risk pregnancies – management options. 4th Ed. Elsevier; 2011:1053-74.

Campbell D, MacGilliray L. Preclampsia in twin pregnancies: incidence and outcome. Hypertension Pregnancy. 1999;18:197-207.

Monde-Agudel A, Belizan J, Lindmark G. Maternal morbidity and mortality associated with multiple gestations. Obstet Gynecol. 2000;95(6Ptl):899-904.

Buhling KJ, Henrich W, Starr E, Lubke M, Bertram S, Siebert G et al. Risk for gestational diabetes and hypertension for women with twin pregnancy compared to singleton pregnancy. Arch Gynecol Obstet. 2003;269:33-6.

Hack KE, Derks JB, Elias SG, Franx A, Roos EJ, Voerman SK et al. Increased perinatal mortality and morbidity in moochorionic versus dichorionic twin pregnancies: Clinical implications of a large Dutch cohort study. BJOG 2008;115(1):58-67.

Baghdadi S, Gee H, Whittle MJ, Khan KS. Twin pregnancy outcome and chorionicity. Acta Obstet Gynecol Scand. 2003;82:18-21.

Hoffmann E, Oldenburg A, Rode L, Tabor A, Rasmussen S, Skibsted L. Twin Births: cesarean Section or vaginal delivery?. Acta Obstetrica et Gynecologica Scandinavica ©2012 Nordic Federation of Societies of Obstetr Gynecol. 2012;91:463-9.

Simoes T, Aboim L, Costa A, Ambroiso A, Alves S, Blickstein I. Puerperal complications following elective cesarean sections for twin pregnancies. J. Perinat. Med. 2007;35:104-7.

Mazhar SB, Peerzada A, Mahmud G. Maternal and perinatal complications in multiple versus singleton pregnancies: A prospective two-year study. J Pak Med Assoc. 2002;52:143-7.






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