Maternal outcome in multiple versus singleton pregnancies in Northern Tanzania: A registry-based case control study

Enid Simon Chiwanga, Gileard Massenga, Pendo Mlay, Joseph Obure, Michael Johnson Mahande
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Objective: To compare maternal outcome of multiple versus singleton pregnancies at a tertiary hospital in Tanzania.

Methods: A case control study was designed using maternally linked data from Kilimanjaro Christian Medical Centre (KCMC) medical birth registry for the period of 2000–2010. A total of 822 multiple gestations (cases) were matched with 822 singletons (controls) with respect to maternal age at delivery and parity. The odds ratio (ORs) with 95% confidence intervals (CIs) for adverse maternal outcome between singleton and multiple gestations were computed in a multivariable logistic regression model.

Results: Of the 33 997 births, there were 822 (2.1%) multiples. Compared with singletons, women with multiple gestations had increased risk for preeclampsia (OR 2.6; 95%CI: 1.7–3.9), preterm labour (OR 5.6; 95%CI: 4.2–7.4), antepartum haemorrhage (OR 1.6; 95%CI: 1.1–2.3), anaemia (OR 2.0; 95%CI: 1.6–2.6) and caesarean section (OR 1.5; 95%CI: 1.4–1.7). In addition, there were six maternal deaths among women with multiple gestations, of which all were attributed to postpartum haemorrhage. This accounted for a case fatality rate of 15.8%.

Conclusions: Multiple gestations are associated with adverse maternal outcomes. Close follow-up and timely interventions may help to prevent poor outcomes related to multiple gestations. These findings suggest the needs for clinicians to counsel women with multiple gestations during prenatal care regarding the potential risks.