Maternal and perinatal outcomes of twin pregnancy in 23 low- and middle-income countries.

<h4>Background</h4>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...

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Autores principales:	Joshua P Vogel, Maria Regina Torloni, Armando Seuc, Ana Pilar Betrán, Mariana Widmer, João Paulo Souza, Mario Merialdi
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/8bedfaa2b3d94fe490026455162eeae6
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spelling	oai:doaj.org-article:8bedfaa2b3d94fe490026455162eeae62021-11-18T09:01:39ZMaternal and perinatal outcomes of twin pregnancy in 23 low- and middle-income countries.1932-620310.1371/journal.pone.0070549https://doaj.org/article/8bedfaa2b3d94fe490026455162eeae62013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23936446/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.Joshua P VogelMaria Regina TorloniArmando SeucAna Pilar BetránMariana WidmerJoão Paulo SouzaMario MerialdiPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 8, p e70549 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Joshua P Vogel Maria Regina Torloni Armando Seuc Ana Pilar Betrán Mariana Widmer João Paulo Souza Mario Merialdi Maternal and perinatal outcomes of twin pregnancy in 23 low- and middle-income countries.
description	<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.
format	article
author	Joshua P Vogel Maria Regina Torloni Armando Seuc Ana Pilar Betrán Mariana Widmer João Paulo Souza Mario Merialdi
author_facet	Joshua P Vogel Maria Regina Torloni Armando Seuc Ana Pilar Betrán Mariana Widmer João Paulo Souza Mario Merialdi
author_sort	Joshua P Vogel
title	Maternal and perinatal outcomes of twin pregnancy in 23 low- and middle-income countries.
title_short	Maternal and perinatal outcomes of twin pregnancy in 23 low- and middle-income countries.
title_full	Maternal and perinatal outcomes of twin pregnancy in 23 low- and middle-income countries.
title_fullStr	Maternal and perinatal outcomes of twin pregnancy in 23 low- and middle-income countries.
title_full_unstemmed	Maternal and perinatal outcomes of twin pregnancy in 23 low- and middle-income countries.
title_sort	maternal and perinatal outcomes of twin pregnancy in 23 low- and middle-income countries.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/8bedfaa2b3d94fe490026455162eeae6
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Maternal and perinatal outcomes of twin pregnancy in 23 low- and middle-income countries.

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