Perinatal outcomes of twin pregnancies complicated with preeclampsia at a tertiary Hospital in Ethiopia: retrospective case–control study

Abstract

Abstract Background: Preeclampsia accounts for 10 to 15 % maternal deaths globally, corresponding to 50,000 annual maternal deaths. Twin pregnancy is a known risk factor for preeclampsia and it is also associated with increased adverse perinatal and maternal outcomes. Three-fold greater perinatal mortality is seen in twin pregnancy in comparison to singleton pregnancies. Prematurity being main contributor of this greater risk of perinatal morality, 50% of twin pregnancies deliver before 37 weeks. Inadequate data exists regarding the clinical characteristics and perinatal outcomes of twin pregnancies with PE. OBJECTIVE: To compare perinatal outcomes of twin pregnancies complicated with preeclampsia (PE) and those without hypertension in a teaching Hospital in Ethiopia. Methodology: A facility based case-control retrospective study was conducted from December 1/2018 – April 30/2019 at St.Paul's Hospital Millennium Medical College( SPHMMC). Data was collected by reviewing medical records, and delivery and NICU registry books. In this study, perinatal outcomes of 63 cases of twin pregnancies complicated with preeclampsia (PE) were compared with 110 normotensive twin pregnancies. Eligible cases were selected based on the inclusion and exclusion criteria among mothers who received care at the hospital from September 2016 to August 2018. Structured questionnaire was used to retrieve data from medical records. Statistical test of association was done using Chi square for categorical data; strength of association with OR and 95% CI .Those variables with P-value of <0.2 on univariate analysis were entered into multivariable logistic regression analysis and adjusted OR was calculated. Results: This study showed that twin gestations complicated with preeclampsia was associated with significantly increased magnitude of preterm birth(61.9% in the preeclampsia group Vs 33.6% in the group without hypertension) with AOR= 2.58and 95thCI(1.34-5.4). Though the AOR for END (2.98), RDS (1.47), and IUGR (1.8) was also increased in the preeclamptic twin gestations, it was not statistically significant. Conclusions: Twin pregnancies complicated with PE were associated with significantly increased rate of preterm birth in our study. Unlike previous study, this study showed no statistically significant association of preeclampsia and of adverse perinatal outcomes, namely RDS, early neonatal death, IUGR, and low Apgar. We recommend a well-designed analytic study to be conducted that may come out with far stronger evidence.