Retrospective audit of the incidence and the maternal and fetal outcomes of twin pregnancies at the Colonial War Memorial Hospital, Suva, Fiji from January 1, 2017 to December 31, 2018

Introduction: Twin pregnancies are associated with an increased risk of complications for both the mother and her babies, especially in developing countries. The purpose, therefore, of this study was to look at the impacts of twin pregnancies and the factors that influence the outcome of twin pregnancies at the Colonial War Memorial Hospital (CWMH) over a 2 year period (2017-2018).
Aim: To determine the incidence of twin pregnancies, factors that influence twin pregnancies, and the maternal and fetal outcomes of twin pregnancies at the maternity unit, in CWMH Suva Fiji from January 1st 2017 to December 31st 2018.
Objectives:
1. To determine the incidence of twin pregnancies at the CWMH Maternity Unit for the study period.
2. To describe the demographic profile of all the women who had twin pregnancies during the study period.
3. To determine the maternal outcomes of twin pregnancies including the mode of delivery during the study period.
4. To determine the fetal outcomes of each twin pregnancy during the study period.
5. To determine the chorionicity of each twin pregnancy during the study period.
Method(s): This is a retrospective descriptive study of 133 twin pregnancies that delivered at the CWMH Maternity Unit from January 1st 2017 to December 31st 2018. A data sheet was developed to collect data from patients’ folders. The data collected included patients’ demographic characteristeristics, adverse maternal and fetal outcomes and the chorionicity of each twin pregnancy. Data waas analysed using SPSS 25 and the results were presented in tables and graphs.
Results: The incidence rate of twins for this study was 1% of the total births and twin birth rate 10 per 1000 births. The maternal factors for twinning are: age 20-29y, multiparity, i-taukei population and maternal family history of twins. A clinically significant increase in adverse maternal outcomes was noted for hypertension in pregnancy, anemia, PROM, CS & PPH. 47% of the study population had a caesarian section, 9% required an EMCS for twin 2 after vaginal delivery of twin 1. NICU admission (11% vs 18%; p = 0.035) & NND (1% vs 5%; p = 0.025) were significant outcomes in twin 2 compared to twin 1. Monochorionic twins are at a higher risk of perinatal mortatility. Late booking compromises the identification of chorionicity to determine pregnancy risks.
Conclusion: Twin pregnancies have additional risks for both the mother and the babies. Difficulty in timely presentation and recognition of twin pregnancies at an early date is a main obstacle. Diagnosis of twin pregnancy and determination of chorionicity is essential to anticipate adverse outcomes associated with monochorionicity.
Optimal antenatal care and surveillance is essential to the early detection of fetal and maternal complications, and determination of timing and mode of delivery.