Maternal and perinatal outcomes in multiple versus singleton pregnancies in Dakar, Senegal: a cross sectional study over 10 years

Mame D. Ndiaye; Mamour Gueye; Ndèye Aissatou Diop; Simon B. Ndour; Ndama Niang; Ndèye G. Fall; Abdoulaye Diakhate; Moussa Diallo; Magatte Mbaye

doi:10.18203/2320-1770.ijrcog20201249

Authors

Mame D. Ndiaye Gynecologic and Obstetric Clinic, Aristide Le Dantec Teaching Hospital, PO Box 3001, Pasteur Avenue, Cheikh Anta Diop University, Dakar, Senegal Philippe Senghor Health Center, PO Box 29026 Dakar, Airport Road, Yoff, Cheikh Anta Diop University, Dakar, Senegal
Mamour Gueye Gynecologic and Obstetric Clinic, Aristide Le Dantec Teaching Hospital, PO Box 3001, Pasteur Avenue, Cheikh Anta Diop University, Dakar, Senegal Philippe Senghor Health Center, PO Box 29026 Dakar, Airport Road, Yoff, Cheikh Anta Diop University, Dakar, Senegal
Ndèye Aissatou Diop Gynecologic and Obstetric Clinic, Aristide Le Dantec Teaching Hospital, PO Box 3001, Pasteur Avenue, Cheikh Anta Diop University, Dakar, Senegal Philippe Senghor Health Center, PO Box 29026 Dakar, Airport Road, Yoff, Cheikh Anta Diop University, Dakar, Senegal
Simon B. Ndour Gynecologic and Obstetric Clinic, Aristide Le Dantec Teaching Hospital, PO Box 3001, Pasteur Avenue, Cheikh Anta Diop University, Dakar, Senegal Philippe Senghor Health Center, PO Box 29026 Dakar, Airport Road, Yoff, Cheikh Anta Diop University, Dakar, Senegal
Ndama Niang Gynecologic and Obstetric Clinic, Aristide Le Dantec Teaching Hospital, PO Box 3001, Pasteur Avenue, Cheikh Anta Diop University, Dakar, Senegal
Ndèye G. Fall Gynecologic and Obstetric Clinic, Aristide Le Dantec Teaching Hospital, PO Box 3001, Pasteur Avenue, Cheikh Anta Diop University, Dakar, Senegal Philippe Senghor Health Center, PO Box 29026 Dakar, Airport Road, Yoff, Cheikh Anta Diop University, Dakar, Senegal
Abdoulaye Diakhate Gynecologic and Obstetric Clinic, Aristide Le Dantec Teaching Hospital, PO Box 3001, Pasteur Avenue, Cheikh Anta Diop University, Dakar, Senegal Philippe Senghor Health Center, PO Box 29026 Dakar, Airport Road, Yoff, Cheikh Anta Diop University, Dakar, Senegal
Moussa Diallo Gynecologic and Obstetric Clinic, Aristide Le Dantec Teaching Hospital, PO Box 3001, Pasteur Avenue, Cheikh Anta Diop University, Dakar, Senegal
Magatte Mbaye Gynecologic and Obstetric Clinic, Aristide Le Dantec Teaching Hospital, PO Box 3001, Pasteur Avenue, Cheikh Anta Diop University, Dakar, Senegal Philippe Senghor Health Center, PO Box 29026 Dakar, Airport Road, Yoff, Cheikh Anta Diop University, Dakar, Senegal

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20201249

Keywords:

Maternal outcome, Multiple pregnancy, Perinatal outcome

Abstract

Background: The birth of twins is a singular event in most societies, and even more when it comes to multiple births. The objective of this study was to investigate maternal and perinatal outcomes in multiple versus singleton pregnancies.

Methods: Cross-sectional study carried out at Philippe Maguilen Senghor health center in Dakar, Senegal from January 1, 2011 to June 30, 2019. Data were extracted from this E-perinatal electronic database and then analyzed in statistical package for social science software (SPSS 24, Mac version).

Results: A total 42,870 mothers delivered 44,149 newborns including 1250 twins (2.8%) and 29 triplets. The mean maternal age was 27 years. Mothers with multiple pregnancies had 3 times the odds of poor maternal outcome compared to mothers with single pregnancies (OR 2.42, 95% CI; 1.98-2.94, p <0.001, for high blood pressure; OR, 2.66; 95% CI, 2.11-3.32, p= <0.001, for severe pre-eclampsia; and OR, 3.04; 95% CI, 1.64-5.66, p <0.001, for postpartum hemorrhage). Likewise, women with multiple gestations had significantly higher rates of preterm birth (OR 5.62; 95% CI: 4.91-6.41, p <0.001), breech presentations (OR = 11.02; CI = 9.68-12.53, p <0.001) and neonatal deaths (OR = 2.94; CI = 9.6852-12.5328 p= 0.004) as compared to women with singleton gestations. Furthermore, women with multifetal gestations had increased risk for caesarean section (OR 2.14; 95% CI: 1.91-2.41, p <0.001) compared with their singleton counterparts. The risks for episiotomy and perineal injuries were higher for women with singleton gestations as compared to multiple gestation mothers.

Conclusions: This study results are in line with previous findings and contradict others. Particular attention should always be paid to multiple pregnancies’ management. However, the pattern of certain complications traditionally correlated with multiple pregnancies is to be confirmed.

Metrics

Metrics Loading ...

References

Guèye M, Ndiaye Guèye MD, Mbaye M, Abdoulaye M, Pison G, Monden C, et al. Twinning rates in developed countries: trends and explanations. population and development review. 2015;41:629-49.

Antoine JM, Audebert A, Avril C, Belaisch-Allart J, Blondel B, Bréart G, et al. Treatments de la sterility et grossness’s multiples en France: analyse et recommendations. Gynécol Obstét Fertil. 2004;7(32):670-83.

Gaucherand P, Polzin K. Accouchement des jumeaux et des triplés. In: Marpeau L, ed. Traité d'obstétrique. Paris: Elsevier Masson; 2010:388-93.

Luke B, Brown MB. Maternal morbidity and infant death in twin vs triplet and quadruplet pregnancies. Am J Obstet Gynecol. 2008;198(4):401.

Wen SW, Demissie K, Yang Q, Walker MC. Maternal morbidity and obstetric complications in triplet pregnancies and quadruplet and higher-order multiple pregnancies. Am J Obstet Gynecol. 2004;191(1):254-8.

Organisation Mondiale de la Santé. Surveillance des soins obstétricaux d’urgence. Manuel Utilization. 2011;173.

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

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.

Gérardin P, Boumahni B, Choker G. Grossness’s gémellaires dans le sud de l’île de la Réunion. J Gynécol Obstét Biol Reprod. 2006;35(8):804-12.

Bricker L. Optimal antenatal care for twin and triplet pregnancy: The evidence base. Best Pract Res Clin Obstet Gynaecol. 2014;28:305-17.

Madar H, Goffinet F, Seco A, Rozenberg P, Dupont C, Deneux-Tharaux C. Severe acute maternal morbidity in twin compared with singleton pregnancies. Obstet Gynecol. 2019;133(6):1141-50.

Andriamady R, Rasoarinavalona A, Ranjalahy R. Prise en charge des grossness’s multiples à la Maternity de Befelatanana Center Hospitalize Universitario d'Antananarivo (Madagascar): à propos de 143 cas. Arch Inst Pasteur Madagascar. 1999;65(2):103-6.

Connolly KA, Getrajdman CS, Bigelow CA, Weintraub AS, Stone JL. Maternal clinical disease characteristics and maternal and neonatal outcomes in twin and singleton pregnancies with severe preeclampsia. Eur J Obstet Gynecol Reprod Biol. 2016;201:36-41.

Chiwanga ES, Massenga G, Mlay P, Obure J, Mahande MJ. Maternal outcome in multiple versus singleton pregnancies in Northern Tanzania: a registry-based case control study. Asian Pacific J Reprod. 2014;3(1):46-52.

Duckitt K, Harrington D. Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. The BMJ. 2005;330:565.

Murray SR, Stock SJ, Cowan S, Cooper ES, Norman JE. Spontaneous preterm birth prevention in multiple pregnancy. Obstet Gynaecol. 2018;20(1):57-63.