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Introduction Twin pregnancy carries a high risk of pregnancy-related complications including adverse perinatal outcomes. Although evidence from international studies indicated an increased risk of adverse perinatal outcomes in twin pregnancies, little is known about the adverse perinatal outcomes in twin pregnancies and associated factors in Ethiopia. The purpose of this study was, therefore, to estimate the incidence of twin pregnancies and related-adverse perinatal outcomes and identify factors associated with adverse perinatal outcomes in twin pregnancies in Ethiopia. Methods A hospital-based retrospective cross-sectional study was conducted among 322 mothers who gave twin birth at Adama Hospital Medical College between 08 July 2015 and 07 June 2017. In this study, the adverse perinatal outcome was defined as the presence of any of the following main conditions: low birth weight, preterm birth, stillbirth, low Apgar Scores, mal-presentation, Admission to neonatal Intensive Care Unit (NICU), and early neonatal deaths. The data were analyzed using SPSS version 20.0. Multivariable logistic regression was conducted to identify factors associated with adverse perinatal outcome at 95% CI or P-value of less than 0.05. Result Of 10,850 births recorded in the hospital, 354 births were twins and 322 of these paired records had complete perinatal information. One hundred ninety-nine (61.8%) of the 322 paired birth records had at least one adverse perinatal outcome on one or both twins. Low birth weight was the most common perinatal outcome followed by preterm birth. After adjusting for confounding factors, younger maternal age (AOR = 4.1, 95% CI; 1.3, 12.5) and not having ultrasound scan during antenatal care (AOR = 2.0, 95% CI: 1.2, 3.1) were significantly associated with adverse perinatal outcomes. Conclusion The incidence of adverse perinatal outcome in twin pregnancies was high, that is, in 61.8% of twin births, there was at least one adverse perinatal outcome on one or both twins. Moreover, younger maternal age at birth and not having an ultrasound scan during antenatal care were found to be strong predictors for the observed high incidence of adverse perinatal outcomes.
A hospital-based retrospective cross-sectional study was conducted among mothers who gave birth to twins at Adama Hospital Medical College (AHMC) between 08 July 2015 and 07 July 2017. Adama Hospital Medical College is one of the largest referral public hospitals located in the Eastern Shoa zone of Oromia Regional State in Ethiopia. The hospital provides both outpatient and inpatient services covering a five million population in the catchment area. The hospital provides obstetrics and gynecology services including antenatal care (ANC), labor and delivery services, and post-natal care. About 5000 mothers attended ANC services and 10, 850 births were registered during the period of 08 July 2015─ 07 June 2017. The study population was all twin births recorded at Adama Hospital Medical College during the study period (08 July 2015 and 07 June 2017) and fulfilled the inclusion criteria. Twin births were included if the birth occurred after 28 weeks of gestational age including a retained second twin. Gestational age at birth was determined using both the Last Normal Menstrual Period and Ultrasound. Birth records with incomplete information about labor and births were excluded from the study. The sample size was calculated using a single population proportion formula considering the following parameters: 95% confidence level that falls within a 4% margin of error, and 16% of mothers who had twin pregnancy. We reduced the margin of error to 4% to increase the quality of data as the reasonable estimate of the key proportion to be studied was less than 50%. Considering the aforementioned parameters the sample was found to be 322. Using the list of twin-births from medical records as a sampling frame, the twin-birth records of 322 were sampled by a simple random sampling method. The dependent variable was the adverse perinatal outcome. In this study, the adverse perinatal outcome was defined as the presence of any of the following main conditions: low birth weight, preterm birth, stillbirth, low Apgar Scores, mal-presentation, Admission to neonatal Intensive Care Unit (NICU), and early neonatal deaths. The independent variables include demographic factors such as maternal place of residence, maternal age at birth, and obstetrics factors including parity, gravida, ANC follow-up, Ultrasound scan during pregnancy and labour, and gestational age at birth. Maternal and birth-related data were collected using various medical records such as birth/delivery logbooks, operation registration books, mother and newborn’s cards, and newborn admission and discharge registration books for those newborns admitted to NICU. All these medical records were reviewed and a structured checklist was used for the data extraction by the trained and authorized data collector. Intensive training was given for the data collectors on the checklist and methods of data extraction. The data collection process, completeness, and consistency of every checklist were regularly monitored and checked by the principal investigator. The checklist used for the data extraction was pretested on 5% of the study sample at Assella Hospital adhering to the similar ethical guidelines that were followed in the actual study. The data were entered and analyzed using SPSS version 20.0. Descriptive statistics were used to describe the main and selected variables included in the study. Bivariate analyses were conducted to investigate the association between each independent factor and outcome variable. The factors which were statistically significant at a P-value of less than 0.05 in bivariate analyses were carried forward into multivariable logistic regressions, where they were adjusted for potential confounders. Finally, after controlling for potential confounders, variables that showed a significant association with the outcome variable at P-value of less than 0.05 were considered as independent predictors of adverse perinatal outcome. Prior to data collection, the study protocol was evaluated and approved by the Ethical Review Committee of Adama Hospital Medical College and the authors were given the approval letter. The Approval letter was then submitted to the department of obstetrics and gynaecology of the hospital to get access to the medical records. When reviewing medical records, confidentiality was strictly maintained by excluding any personal identifiers and by restricting data access only to the authorized people.
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