Multiple pregnancy and preterm labor

OBJECTIVE: Multiple gestations are high risk pregnancies, which may be complicated by pre-maturity, low birth weight infants, pre-eclampsia, anemia, postpartum hemorrhage, intrauterine growth restriction, neonatal morbidity and high perinatal, neonatal and infant mortality. This study was carried out to determine the incidence and effect of multiple pregnancies on pre-term labor in tertiary care hospitals.

METHODS: Retrospective case record analysis of 375 cases of multiple pregnancies that were reported at Armed Forces Hospital and King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia, between January 2000 and December 2001. The data was analyzed to determine the incidence of multiple pregnancies and its effect on pre-term delivery.

RESULTS: The over whole incidence of twins was 14/1000 births. Premature labor in multiple pregnancies was 7 times greater than singletons (42% versus 6.4%). Almost half of multiple pregnancy cases were delivered by cesarean section (49% versus 14%). Pregnancy was induced in 34% of cases. Cervical cerclage was applied in only 8% of cases and betamemetics were administered to only 11% of cases. Fetal distress in labor, abnormal presentation and previous uterine scar were the main indications for cesarean section. Fifty percent had no antenatal complications, gestational diabetes complicated 16%, and anemia was reported in 22% of cases.

CONCLUSION: Preterm delivery remains the most serious complication of multiple pregnancies. Multiple gestation children may suffer long term sequel of prenatal complications, including cerebral palsy and hearing disabilities. Every effort should be made to reduce the risk of multiple gestation and pre-term labor through proper control and close monitoring of fertility drugs, limiting number of embryo transfer to maximum of 3 or only 2, improving the socioeconomic status of expectant mothers, reduce cigarette smoking, relieve maternal stress, restriction of maternal activity, frequent contact with health care personnel and treatment of any obstetric or medical disorders.