Maternal complications in twin pregnancy; recent trends: a study at a tertiary care referral institute in Northern India


  • Sunita Dubey Department of Obstetrics and Gynecology, Government Medical College and Hospital, Chandigarh, India
  • Reeti Mehra Department of Obstetrics and Gynecology, Government Medical College and Hospital, Chandigarh, India
  • Poonam Goel Department of Obstetrics and Gynecology, Government Medical College and Hospital, Chandigarh, India
  • Jyotsna Rani Department of Obstetrics and Gynecology, Government Medical College and Hospital, Chandigarh, India
  • Mohit Satodiya Department of Obstetrics and Gynecology, Government Medical College and Hospital, Chandigarh, India



Multiple pregnancies, Preterm labour, Preterm rupture of membranes, Preeclampsia, Twin pregnancy


Background: This study aims to determine the maternal complications in twin pregnancy in North Indian population at tertiary institute.

Methods: This was a retrospective cohort review of multiple pregnancies after 20 weeks gestation at a tertiary teaching hospital (2011-2015). Maternal data was collected from the labor room delivery data entry register and patient’s admission file. Patients with diabetes mellitus and chronic hypertension were excluded from the study.

Results: Out of 19539 births during this period, 432 were twin pregnancies with an incidence of 22/1000 birth. Most of them were 282 (65.4%) were referred patients. Eighty seven percent patients were in the age group of 21-30 years and primigravida contributed to 45.7% of total patients. Maternal complications noticed were as preterm deliveries in 304 (70%), anaemia in 259(60%) patients, preterm rupture of membranes in 120 (39.4%) patients, hypertensive disorders of pregnancy in 122(28.3%) patients, cholestasis of pregnancy in 24(5.5%) of patients, hypothyroidism in 22(5.1%) of patients, antepartum hemorrhage (APH) in 20(4.6%) and gestational diabetes mallitus (GDM) in 08(1.8%) of patients. Among postpartum complications, atonic postpartum haemorrhage (PPH) was observed in 44 (10.2%) and maternal mortality happened in 02(0.46%) cases.

Conclusions: This study reveals higher percentage of, preterm labor, anaemia, and gestational hypertension than other studies. More number of intensive care unit should be established in high prevalence areas to prevent perinatal mortality due to prematurity. Treatment of anaemia requires more aggressive approach by considering intravenous iron whenever compliance is in doubt. Frequent antenatal care is required for early diagnosis of these complications to prevent maternal and fetal morbidity.


Practice committee of american society for reproductive medicine. Multiple gestation associated with infertility therapy: an American Society for Reproductive Medicine Practice Committee opinion. Fertil Steril 2012; 97:825.

Lisonkova S, Joseph KS, Bell R, Glinianaia SV. Effect of advanced maternal age on perinatal outcomes in twins: the impact of chorionicity. Ann Epidemiol. 2013 Jul 1;23(7):428-34.

Nkyekyer K. Multiple pregnancy. In: Kwawukume EY, Emuveyan EE, editors. Comprehensive Obstetrics in the Tropics. 1st ed. Asante and Hittscher Printing Press Limited; 2002. p. 162-72.

Adashi EY. Seeing double: a nation of twins from sea to shining sea. Obstetr Anesthesia Digest. 2017 Mar 1;37(1):16.

Hamilton BE, Martin JA, Osterman MJ, Curtin SC, Matthews TJ. Births: Final data for 2014. Natl Vital Stat Rep. 2015;64(2):1-64.

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

Kametas NA, McAuliffe F, Krampl E, Chambers J, Nicolaides KH. Maternal cardiac function in twin pregnancy. Obstetr Gynecol. 2003 Oct 1;102(4):806-15.

Sibai BM, Hauth J, Caritis S, Lindheimer MD, MacPherson C, Klebanoff M, et al. Hypertensive disorders in twin versus singleton gestations. Am J Obstetr Gynecol. 2000 Apr 1;182(4):938-42.

Rao A, Sairam S, Shehata H. Obstetric complications of twin pregnancies. Best Prac Res Clin Obstet Gynaecol. 2004 Aug 1;18(4):557-76.

Buhling KJ, Henrich W, Starr E, Lubke M, Bertram S, Siebert G, Dudenhausen JW. Risk for gestational diabetes and hypertension for women with twin pregnancy compared to singleton pregnancy. Arch of Gynecol Obstetr. 2003 Nov 1;269(1):33-6.

Ananth CV, Demissie K, Smulian JC, Vintzileos AM. Placenta previa in singleton and twin births in the United States, 1989 through 1998: a comparison of risk factor profiles and associated conditions. Am J Obstetr Gynecol. 2003 Jan 1;188(1):275-81.

Santana DS, Cecatti JG, Surita FG, Silveira C, Costa ML, Souza JP, et al. Twin pregnancy and severe maternal outcomes: the World Health Organization multicountry survey on maternal and newborn health. Obstetr Gynecol. 2016 Apr 1;127(4):631-41.

Implementation of the ANC guideline and recommendations. WHO recommendations on antenatal care for a positive pregnancy experience. 2016;4:105-7.

Deepthi HR, Pradeep MR, Lalitha S. Retrospective study of maternal and perinatal outcome of twin pregnancy in a teaching hospital. J Dental Med Sci. 2015;14(1): 29-32.

Tomar SP, Kushwah SS, Kushwah AP. Association of sociodemographic factors with multiple births and birth outcomes in comparison to single births among deliveries conducted at a tertiary hospital in Rewa, Madhya Pradesh. Int J Students’ Res. 2014 Jan 1;4(1):8.

Rezavand N, Veisi F, Malek-Khosravi S, Zangeneh M, Kohzadi M. Assessment of Frequency of Twin Pregnancy and Neonatal Outcome in Deliveries of Mo’tazedi Hospital, Kermanshah in 2004-2007. J Obstetr Gynecol India. 2014 Feb 1;64(1):19-22.

Nandmer GK, Kanhere AV. Study of obstetric and fetal outcome of twin pregnancy in a tertiary care centre. Int J Reprod Contracept Obstetr Gynecol. 2017 Feb 19;4(6):1789-92.

Shetty MB, Shivananjaiah C, Swarup A. A retrospective study: twin gestation at tertiary care, maternal and fetal outcome. Int J Reprod Contracept Obstetr Gynecol. 2016 Dec 16;5(1):217-9.

Chowdhury S, Hussain MA. Maternal complications in twin pregnancies. Mymensingh Med J. 2011 Jan;20(1):83-7.

Sheela SR, Patila A. A study of maternal and fetal outcome in multifetal gestation at a rural based teaching hospital-a retrospective analysis. Int J Biol Med Res. 2014;5(2):3994-7.

Assunção RA, Liao AW, Brizot MD, Krebs VL, Zugaib M. Perinatal outcome of twin pregnancies delivered in a teaching hospital. J Brazilian Med Ass. 2010;56(4):447-51.

Gonzalez MC, Reyes H, Arrese M, Figueroa D, Lorca B, Andresen M, et al. Intrahepatic cholestasis of pregnancy in twin pregnancies. J Hepatol. 1989 Jul;9(1):84-90.

Vogel JP, Torloni MR, Seuc A, Betrán AP, Widmer M, Souza JP, et al. Maternal and perinatal outcomes of twin pregnancy in 23 low-and middle-income countries. PloS one. 2013 Aug 1;8(8):e70549.






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