RESEARCH – March 2009

Twin pregnancy: maternal risks, pregnancy complications, obstetric and perinatal outcome at the Women’s Clinic of Tartu University Hospitals (2003–2007)


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AIM. To analyse the outcome and complications related to twin pregnancies conceived spontaneously and with assisted reproduction technologies (ART).
METHODS. A reprospective analysis of the medical histories of 183 twin pregnancies at the Women’s Clinic of Tartu University Hospital in 2003–2007. Comparison of the  data with the data of all births registered in the Estonian Medical Birth Registry in 2003–2007.
Twin deliveries account for 1.7% of all births at the Women’s Clinic of Tartu University Hospital. Compared to the data of all births in Estonia, women with twins suffered more frequently from anaemia  (56.2% vs 20.1%), preterm labour (30.6% vs 4.3%), preterm delivery (57.9% vs 5.8%) and preeclampsia (10.9% vs 2.7%). PPROM (preterm premature rupture of membranes) affected 27.3% and pregnancy induced hypertension affected 16.3% of women with twin pregnancy. Of the mothers 9.8% received blood transfusion after delivery. The rate of Cesarean section for twin pregnancies was three fold higher than for all births (57.9% vs 18.5%). No differences occurred in the incidence of any complications between spontaneous (n=148) and ART (n=35) twin pregnancies but ART-twins were more frequently delivered by cesarean section (74.3% and 54.1%, respectively). Perinatal mortality of twins was five times higher than that for all births (3.6% vs  0.7%). There was observed no difference in perinatal mortality between the use of either twin and conception method. However, twin B had more frequently a low Apgar score and lower umblical cord blood pH than twin A after vaginal delivery. Most of the babies born in asphyxia from vaginal delivery were premature (gestational age 23+5 – 28+0 weeks) with very low birth weight (<1500 g).
CONCLUSIONS. Twin pregnancy is related to higher risk for mothers and babies. Outcome for pregnancy complications does not differ for spontaneously conceived and ARTtwin pregnancies. Prematurity rather than the delivery method is the reason for poor perinatal outcome.