Clinical Medicine Research
Volume 7, Issue 1, January 2018, Pages: 18-25
Received: Feb. 7, 2018;
Accepted: Feb. 25, 2018;
Published: Mar. 22, 2018
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Ikeanyi Eugene Maduabuchukwu, Department of Obstetrics and Gynecology, Niger Delta University, Amassoma, Nigeria
Ikobho Ebenezer Howell, Department of Obstetrics and Gynecology, Niger Delta University, Amassoma, Nigeria
Background: Twin pregnancy is as fascinating as it is high risk and its epidemiology is globally more dynamic in the recent times. It is associated with increase maternal morbidities, fetal wastage and neonatal morbidities and mortality. Objectives: To determine the current incidence, assess the trend and investigate maternal and perinatal outcomes and influencing factors of twinning. Methods: For this case control study, data was collected on twin pregnancies; the study group and singleton pregnancies; the control group between January 2009 and December 2016 at a missionary Hospital in south-south Nigeria. EPI INFO and INSTAT statistical software were used for analyses and Fisher’s exact test for tests of statistical associations setting the statistical significance at <.05. Results: Among 8769 deliveries were 207 pairs of twins, a twinning incidence of 2.4% or 1 in 42 with an upward trend in incidence. Twin mothers were relatively older with those aged 30-34 years (41.2%) as the modal age group, less literate and less likely to have prenatal care. They were more prone to anemia, caesarean birth, Postpartum hemorrhage, gestational hypertension and blood transfusion (P<0.05). Mean gestational age and birth weight of twins were 35.5±3.8 weeks and 2352.9±746.4gm respectively. The twins were associated with increased preterm births (OR 28.1, P<0.001), Low birth weight (OR 15.6-24.1, P<0.001), perinatal death (OR 3.6, P<0.001), birth asphyxia (OR 2.9-5.9, P<0.01) and Special Care Baby Unit admission (OR 9.8-12.5, P<0.001). About 7 (66.2%) and 3 (31.4%) of every 10 first twins were in cephalic and breech presentation respectively with cephalic/cephalic (44.0%) the leading paired presentations. Conclusion: There was high and increasing incidence of twinning in this population. Twin pregnancy is associated with increased maternal morbidity and perinatal morbidity and mortality. To improve twinning outcome will require quality obstetric and perinatal care.
Ikeanyi Eugene Maduabuchukwu,
Ikobho Ebenezer Howell,
A Review of Twinning in Niger Delta Region, Nigeria, Clinical Medicine Research.
Vol. 7, No. 1,
2018, pp. 18-25.
Vogel JP, Torloni MR, Seuc A, Betrán AP, Widmer M, Souza JP, Merialdi M. Maternal and Perinatal Outcomes of Twin Pregnancy in 23 Low- and Middle-Income Countries PLoS ONE 2013; 8 (8): e70549. doi:10.1371/journal.pone.0070549.
Smits J, Monden C Twinning across the Developing World. Plos One 2011; 6: e25239 doi:10.1371/journal.pone.0025239.
Fisk NM. Multiple Pregnancy. Dewhurst Textbook of Obstetrics and Gynaecology. Edmonds DK eds, 7th edition, Blackwell Publishers 2007; 166-176.
Hamilton BE, Martin JA, Osterman MJ, Curtin SC, Mathews TJ. Births: Final Data for 2014. Natl Vital Stat Rep.2015; 64 (12):1-64.
Hoekstra C, Zhao ZZ, Lambalk CB, Willemsen G, Martin NG, Boomsma DI, Montgomery GW. Dizygotic twinning. Human Reprod Update. 2008; 14 (1): 37–47. [PubMed].
Bortolus R, Parazzini F, Chatenoud L, Benzi G, Bianchi MM, Marini A. The epidemiology of multiple births. Human Reprod Update. 1999; 5 (2):179–187. [PubMed].
Lichtenstein P, Olausson PO, Kallen AJ. Twin births to mothers who are twins: A registry based study. BMJ. 1996; 312: 879–881. [PubMed].
Basso O, Nohr EA, Christensen K, Olsen J. Risk of twinning as a function of maternal height and body mass index. JAMA. 2004; 291:1564–1566. [PubMed].
Bush MC, Pernoll ML. Multiple pregnanacy. In: DeCherny AH, Nathan L, Goodwin TM, Laufer N, editors. Currrent diagnosis and treatment, obstetrics and gynecology. 10th ed. New York, NY: McGraw Hill; 2007. pp. 301–10.
Aisien A, Olarewaju R Twins in Jos Nigeria: a seven-year retrospective study. Med Sci Monit 2000; 6: 945–50.
Obiechina N, Okolie V, Eleje G Twin versus singleton pregnancies: the incidence, pregnancy complications, and obstetric outcomes in a Nigerian tertiary hospital. Int J Womens Health 2011: 227–230.
Onyiriuka AN Twin delivery: comparison of incidence and foetal outcome in two health institutions in Benin city, Nigeria. Nig Q J Hosp Med. 2009; 19 (1):1-5.
Abasiattai AM, Umoiyobo AJ, Utuk NM, Shittu DG. Incidence and mode of delivery of twin pregnancies in Uyo, Nigeria. Niger Med J 2010; 51:170-2.
Bassey EA, Abasiattai AM, Udoma EJ, Asuquo EE. Outcome of twin pregnancy in Calabar, Nigeria. G J Med Sci. 2004; 3:13–15.
Mutihir JT, Pam VC. Obstetric outcome of twin pregnancies in Jos, Nigeria. Niger J Clin Pract. 2007; 10:15–8. [PubMed].
Sunday-Adeoye I., Twomey E. D., Egwuatu V. E. A 20-year review of twin births at Mater Misericordiae Hospital, Afikpo, South Eastern, Nigeria. Nig J Clin Pract 2008; 11 (3): 231-234.
Attah RA, Mohammed Z, Gobir M. A Review of twin deliveries in Aminu Kano Teaching Hospital, North-West, Nigeria. Niger J Basic Clin Sci 2014; 11:3-7.
Nwobodo EI, Bobzom DN, Obed J. Twin births at University of Maiduguri Teaching Hospital: incidence, pregnancy complications and outcome. Niger J Med. 2002; 11:67–9. [PubMed].
Akinboro A, Azeez MA, Bakare AA. Frequency of twining in southwest Nigeria. Indian J Hum Genet 2008; 14 2):41-47.
Nwankwo TO, Aniebue UU, Ezenkwele E, Nwafor MI. Pregnancy outcome and factors affecting vaginal delivery of twins at University of Nigeria Teaching Hospital, Enugu. Niger J Clin Pract 2013; 16:490-5.
Akaba GO, Agida TE, Onafowokan O, Offiong RA, Adewole ND. Review of Twin Pregnancies in a Tertiary Hospital in Abuja, Nigeria. J Health Popul Nutr 2013; 31 (2):272-7.
Isa Ibrahim, Abisoye Oyeyemi, Abhulimen Obilahi. Twin pregnancies in the Niger Delta of Nigeria: a four-year review. IntJ Womens Health 2012; 4: 245-249. Doi:10.2147/IJWH. S31350.
Kontopoulos EV, Ananth CV, Smulian JC, Vintzileos AM. The impact of route of delivery and presentation on twin neonatal and infant mortality: a population-based study in the USA, 1995-97. J Matern Fetal Neonatal Med. 2004; 15: 219–24. [PubMed].
Dera A, Breboorowicz GH, Keith L. The mode of delivery in twin pregnancy part 2 maternal outcome. Arch Perinat Med 2008; 14:7-14.
Smith GC, Pell JP, Dobbie R. Birth order, gestational age, and risk of delivery related perinatal death in twins: retrospective cohort study. Br Med J 2002; 325, 1004.
Kuti O, Owolabi AT, Fasuba OB. Outcome of twin pregnancy in a Nigerian Teaching Hospital. Trop. J Obstet Gynaecol 2006; 23:132-5.
Martin J. A., Hamilton B. E., Sutton P. D. Ventura SJ, Menacker F, Munson ML Births: final data for 2002 Natl. VitalStat. Rep.2003, 52 (10):1-113.
Onyiriuka AN, Ikeanyi EM. Sex Ratio at Birth: A Retrospective Audit of the Birth Records of a Nigerian Hospital. NJOG 2015; 19 (1):85-88.
Kapoor M Epidemic of plurality and contributions of assisted reproductive technology therein. Am J Med Genet C Semin Med Genet 2009; 15: 128–135.