title: Reappraisal of twinning: epidemiology and outcome in the early neonatal period.
abstract: BACKGROUND
  The present study aimed to determine the epidemiology, maternal complications and adverse neonatal outcomes associated with twin births at a tertiary care hospital in India.
  
  
  METHODS
  A prospective observational study was conducted on all successively born twin pairs (≥ 23 weeks of gestation) and their mothers from January to September 2005. Main outcome measures included maternal medical/obstetric complications, labour characteristics and the morbidities/mortality observed during the early neonatal period.
  
  
  RESULTS
  The twinning rate was 1 in 54 deliveries. Around 10% of mothers had a predisposition for twinning in the form of familial tendency or consumption of clomiphene. Anaemia (85%) was the most common maternal complication, followed by gestational hypertension (17%). Nearly one-third of births were delivered via Caesarean section. Prematurity (61%) was the most common neonatal complication followed by early-onset neonatal sepsis (21%). The risk of early neonatal death was 27%. Shorter gestation and low birth weight were significantly associated with adverse neonatal outcome (p < 0.05). Factors such as chorionicity, mode of delivery, birth order, inter-twin delivery time interval, gender and intra-pair birth weight discordance did not affect neonatal morbidity or mortality (p ≥ 0.05).
  
  
  CONCLUSIONS
  The rates of maternal complications and early neonatal morbidities/mortality were quite high in twin gestations. Except for the prematurity and low birth weight, none of the other factors, including inter-twin delivery time interval of more than 15 mins, were found to affect neonatal outcome.
authors.affiliation: WZ-D/14-15, Dayal Sir Road, Uttam Nagar, New Delhi 110059, India. drpriyankaguptakapil@gmail.com.
authors.forename: P
authors.initials: P
authors.lastname: Gupta
authors.forename: M M
authors.initials: MM
authors.lastname: Faridi
authors.forename: N
authors.initials: N
authors.lastname: Goel
authors.forename: Z H
authors.initials: ZH
authors.lastname: Zaidi
mesh_terms: D000328:Adult; D000740:Anemia / Q000150:complications; D002585:Cesarean Section; D016640:Diabetes, Gestational / Q000453:epidemiology; D005260:Female; D006801:Humans; D007194:India; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome; D059285:Pregnancy, Twin; D011446:Prospective Studies; D018805:Sepsis; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D014427:Twins