Vidhyalakshmi, K (2022) A Prospective study on Maternal and Perinatal Outcome in Multiple Pregnancy. Masters thesis, Madras Medical College, Chennai.
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Abstract
BACKGROUND: Multiple pregnancy is a well-recognized risk factor that increases maternal and perinatal morbidity and mortality Maternal mortality is 2.5 times higher in multiple pregnancy when compared to singleton pregnancy and in that line the neonatal morbidity and mortality is 6 times higher for a multiple pregnancy when compared to a singleton. All obstetricians need to appreciate the unique development of multiple pregnancies and the importance of specialized antenatal care in their management. The current study aims to asses sociodemographic, obstetric characteristics and the occurrence of maternal complications in multiple pregnancy and its associated adverse perinatal outcome. METHODS: It is a prospective observational study on 200 cases of twins admitted at our hospital Detailed history will be taken, general and systemic examination will be done, all routine and specific investigations will be done. Data will be collected by proforma containing demographic details, present, past, family history, antepartum, intrapartum, postpartum complications, neonatal outcome and complications and perinatal mortality. ❖ All these patients were delivered in our hospital Under close observation ❖ All stages of labour were carefully managed in the presence of team of obstetricians. ❖ All babies were examined by neonatologist and NICU care was given as and when required Necessary information will be collected in a pre designed data sheet and finally the findings will be compiled and analysed. RESULTS: 200 multiple pregnancy cases were studied in our institute, out of which 98% of the cases were booked, 61% of them are primi gravida and 39% of them were multigravida.78% of them delivered at a gestational age less than 36 weeks, preterm delivery. 71% of them conceived spontaneously and 29% conceived after assisted reproductive techniques out of which, 19% were out of IVF conception.63% of them were DCDA, 29% were of MCDA, 4% were MCMA, 3.5% of them were TCTA. Various maternal complications and its percentage associated with multiple pregnancy among them, preterm delivery is the most common complication about 62%, and the second one is postpartum hemorrhage 22.5%. Followed by anemia 20%, other rare complications include single fetal demise, fetal growth restriction weighs about 4.5% 74 and 5.5% respectively, though it is rare it is specific for multiple pregnancy. ❖ Cesarean mode of delivery is the most common mode of delivery when it comes to multiple pregnancy, which accounts for 63%. ❖ Among indications for cesarean deliveries , non cephalic presentation of first twin pose the major threat to increase the primary cesarean section rate, followed by fetal distress , all the 6 TCTA triplets were delivered by cesarean mode of delivery keeping in mind the prematurity of the fetuses and most of them had growth restriction. ❖ From our study it is evident that birth weight of twin babies mostly fall in the range of 2.1 to 2.5 this can be extrapolated to the preterm nature of the babies of multiple pregnancy. ❖ With regards to APGAR, 5 minute apgar less than 8 was found in 89% of twin 1 and 91% of twin 2 and 100% of triplet 3. Among neonatal complications, 5 minute apgar less than 8 was found in 89% of twin 1 and 91% of twin 2 and 100% of triplet 3. 51% of babies had NICU admissions the number were quite large when compared to singleton pregnancy and 5.5 % babies had birth asphyxia and 4% of the admitted babies developed neonatal seizures and 3.5% babies developed sepsis. CONCLUSION: A dramatic increase in the numbers of multiple births in developed countries has stimulated interest in the progress and outcome of such pregnancies. As well as considerable health risks, the social, psychological and financial impact of multiple births, especially higher order multiple births, has been highlighted. ❖ This study revealed higher percentage preterm labour, anemia, gestational hypertension in twin pregnancy as compared to other studies. Anaemia, hypertensive disorder of pregnancy along with postpartum haemorrhage are the well-known causes of maternal mortality, thus frequent antenatal visits should be aimed to detects maternal complications earlier. Aggressive treatment of anemia with intravenous iron should be considered whenever there are adverse effects or noncompliance to oral iron. Atonic postpartum haemorrhage should be anticipated in all multiple pregnancies, therefore prophylactic treatment should be prearranged for its prevention.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221916905 |
| Uncontrolled Keywords: | Maternal and Perinatal Outcome, Multiple Pregnancy, Prospective study. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology > MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 17 Apr 2022 06:45 |
| Last Modified: | 29 Nov 2023 11:13 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/19302 |
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