Maternal and perinatal outcomes of twin pregnancy in 23 low- and middle-income countries.
BACKGROUND
Twin pregnancies in low- and middle-income countries (LMICs) pose a high risk to mothers and newborns due to inherent biological risks and scarcity of health resources. We conducted a secondary analysis of the WHO Global Survey dataset to analyze maternal and perinatal outcomes in twin pregnancies and factors associated with perinatal morbidity and mortality in twins.


METHODS
We examined maternal and neonatal characteristics in twin deliveries in 23 LMICs and conducted multi-level logistic regression to determine the association between twins and adverse maternal and perinatal outcomes.


RESULTS
279,425 mothers gave birth to 276,187 (98.8%) singletons and 6,476 (1.2%) twins. Odds of severe adverse maternal outcomes (death, blood transfusion, ICU admission or hysterectomy) (AOR 1.85, 95% CI 1.60-2.14) and perinatal mortality (AOR 2.46, 95% CI 1.40-4.35) in twin pregnancies were higher, however early neonatal death (AOR 2.50, 95% CI 0.95-6.62) and stillbirth (AOR 1.22, 95% CI 0.58-2.57) did not reach significance. Amongst twins alone, maternal age <18, poor education and antenatal care, nulliparity, vaginal bleeding, non-cephalic presentations, birth weight discordance >15%, born second, preterm birth and low birthweight were associated with perinatal mortality. Marriage and caesarean section were protective.


CONCLUSIONS
Twin pregnancy is a significant risk factor for maternal and perinatal morbidity and mortality in low-resource settings; maternal risk and access to safe caesarean section may determine safest mode of delivery in LMICs. Improving obstetric care in twin pregnancies, particularly timely access to safe caesarean section, is required to reduce risk to mother and baby.
School of Population Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Western Australia, Australia. vogeljo@who.int
Joshua P
JP
Vogel
Maria Regina
MR
Torloni
Armando
A
Seuc
Ana Pilar
AP
Betrán
Mariana
M
Widmer
João Paulo
JP
Souza
Mario
M
Merialdi
D000293:Adolescent; D000328:Adult; D003625:Data Collection; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007182:Income; D007231:Infant, Newborn; D008297:Male; D009035:Mothers / Q000706:statistics & numerical data*; D011247:Pregnancy; D011256:Pregnancy Outcome; D059285:Pregnancy, Twin; D014944:World Health Organization; D055815:Young Adult