Perinatal outcomes of multiple-gestation pregnancies in Kenya, Zambia, Pakistan, India, Guatemala, and Argentina: a global network study
Marete, I.; Tenge, C.; Pasha, O.; Goudar, S.; Chomba, E.; Patel, A.; Althabe, F.; Garces, A.; McClure, E.M.; Saleem, S.; Esamai, F.; Kodkany, B.S.; Belizan, J.M.; Derman, R.J.; Hibberd, P.L.; Krebs, N.; Buekens, P.; Goldenberg, R.L.; Carlo, W.A.; Wallace, D.; Moore, J.; Koso-Thomas, M.; Wright, L.L.; Liechty, E.A.
American Journal of Perinatology 31(2): 125-132
2014
ISSN/ISBN: 1098-8785 PMID: 23512321 DOI: 10.1055/s-0033-1338173Document Number: 623185
To determine the rates of multiple gestation, stillbirth, and perinatal and neonatal mortality and to determine health care system characteristics related to perinatal mortality of these pregnancies in low- and middle-income countries. Pregnant women residing within defined geographic boundaries located in six countries were enrolled and followed to 42 days postpartum. Multiple gestations were 0.9% of births. Multiple gestations were more likely to deliver in a health care facility compared with singletons (70 and 66%, respectively, p < 0.001), to be attended by skilled health personnel (71 and 67%, p < 0.001), and to be delivered by cesarean (18 versus 9%, p < 0.001). Multiple-gestation fetuses had a relative risk (RR) for stillbirth of 2.65 (95% confidence interval [CI] 2.06, 3.41) and for perinatal mortality rate (PMR) a RR of 3.98 (95% CI 3.40, 4.65) relative to singletons (both p < 0.0001). Neither delivery in a health facility nor the cesarean delivery rate was associated with decreased PMR. Among multiple-gestation deliveries, physician-attended delivery relative to delivery by other health providers was associated with a decreased risk of perinatal mortality. Multiple gestations contribute disproportionately to PMR in low-resource countries. Neither delivery in a health facility nor the cesarean delivery rate is associated with improved PMR.