TITLE:
Complications of Twin Delivery and Associated Factors: A Hospital-Based Cross-Sectional Analytical Study in Yaoundé
AUTHORS:
Jeanne Hortence Fouedjio, Cliford Ebong Ebontane, Fouelifack Ymélé Florent, Janvier Binwe, Isidore Tompeen, Esther Meka, Owno Paul Etoundi
KEYWORDS:
Post-Partum Hemorrhage, Prenatal Visit, Ultrasound, Twin Birth
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.13 No.8,
August
21,
2023
ABSTRACT: Background: Twin birth is considered a high-risk obstetrical situation. Despite the
progress in obstetrical and pediatric care that has occurred in recent years,
twin delivery is still associated with high maternal morbidity and perinatal
mortality. Few recent studies have focused on the complications and risk
factors associated with complications of twin birth in our environment. The
objective of our study was to identify the complications of twin birth and the factors associated with them. Methodology: We
carried out a cross-sectional analytical study. Data collection was prospective,
over a period of 4 months (January 1, 2022 to
April 30, 2022), at the maternity units of the Gyneco-Obstetric and Pediatric
Hospital of Yaoundé and the Central Hospital of Yaoundé. The study population included
all pregnant women who gave birth to twins during our study period at these hospitals.
Data analysis was done using the SPSS software (Statistical Package for the Social
Sciences) version 23.0. The Chi-square test was used to compare proportions and
the student’s t test to compare means. A p-value of less than 0.05 was considered
statistically significant. Results: In total, we recorded 37 complicated
twin deliveries out of a total of 66 twin deliveries. This corresponded to a
complication rate of 56%. Maternal complications occurred in 11.38% of cases,
the majority being soft tissue lesions (4.54%), and postpartum hemorrhage
(4.54%). Perinatal complications at the time of delivery were dominated by
early neonatal infections (12.12%), non-reassuring fetal condition (10.6%) and
intrauterine fetal death (6.06%). Factors associated with complications of twin
births after univariate analysis were: maternal age ≤ 30 years (OR = 8.15; CI =
9.78 - 71.06; P = 0.03), being a student, (OR = 5.09; CI = 3.65 - 7.10; P = 0.00),
primary level of education (OR = 1.48; CI = 3.30 - 6.63; P = 0.00), having less
than four prenatal contacts (OR = 5.76; CI = 12.2 - 27, 24; P = 0.02), lack of
ultrasound assessments (OR = 2.65; CI = 1.08 - 4.65, P = 0.04), diagnosis of twinning at labor (P = 0.03), admission for
preeclampsia and eclampsia (OR = 2.01; CI = 1.24 - 5.9; P = 0.04),
qualification of birth attendant as midwife (OR = 2.33; CI = 6, 38 - 8.50; P = 0.00),
delivery time greater than 15 minutes for the second twin (OR = 2.45; CI = 1.14
- 5.26; P = 0.019). Conclusion: twin birth remains associated with high
maternal and neonatal morbidity in our environment. The rate of maternal-fetal
complications is 56% in our series. Post-partum hemorrhage, soft tissue injury
and early neonatal infections are the main complications. These are closely
linked to a number of factors whose control would improve the prognosis of twin
birth.