EVALUATION OF FETAL AND MATERNAL OUTCOMES IN MULTIPLE PREGNANCIES

Abstract

Multiple pregnancies are an important topic of obstetrics as they are interesting and carry high risk. The increasing use of ultrasonography (USG) has made it possible to detect multiple pregnancies early. In the last 30 years, there has been a significant increase in the number of multiple pregnancies, especially in developed countries, with the increase in gestational age and the use of progressively developing assisted reproductive techniques (ART). Complications related to preterm birth and prematurity are observed with an increased frequency in these pregnancies. Therefore, multiple pregnancies constitute a process that should be monitored much more closely than singleton pregnancies due to many accompanying maternal and fetal complications. In this study, it was aimed to evaluate the maternal and fetal outcomes of multiple pregnancies with assisted reproductive techniques or spontaneous delivery in our clinic. Among all pregnant women who gave birth in our hospital between January 2018 and March 2022, 53 multiple pregnancies were included in the study. Maternal age, gestational week, delivery history, mode of delivery, birth weight and apgar scores (1st and 5th minutes) of the patients in the hospital database and file records were evaluated in terms of obstetric pathologies and perinatal outcomes. Level 1 and level 2 ultrasonography measurements and Doppler ultrasonography measurements of all patients were made by our radiology doctor in our hospital. Patient follow-ups were managed by the same gynecologist and obstetrician. There was no significant difference in the mean age of the participants according to birth weight, week of birth and mode of delivery (p>0.05). There was a significant difference in the mean age of the participants according to the presence of maternal hypertension (p<0.05). There was a statistically significant relationship between birth weight and multiple pregnancy status (p<0.05). The rate of birth weight of <1000 g and 1000-1500 g was higher in triplet pregnancies, and birth weight was found to be significantly lower than in twin pregnancies and this finding is consistent with the literature. There was a statistically significant relationship between the week of birth and multiple pregnancy status (p<0.05). The frequency of delivery between 24-28 and 28-32 weeks in triplet pregnancies was found to be significantly higher than in twin pregnancies and this finding is consistent with the literature. There was no statistically significant relationship between the presence of maternal Diabetes Mellitus (DM) and Hypertension (HT) and twin and triplet pregnancies (p>0.05). A statistically significant difference was found between twin pregnancy and triplet pregnancy in terms of both Apgar 1st Minute and Apgar 5th Minute scores (p<0.05). Both Apgar scores were higher in twin pregnancies. In a similar study, a high correlation and a statistically significant relationship was found between the 1st and 5th minute Apgar scores and the week of birth. One of the most determining factors on perinatal morbidity in multiple pregnancies is chorionicity. Perinatal outcomes are particularly related to week of birth and chorionicity. The biggest limitation of our study is the lack of sonographic evaluation of chorionicity in our file record information. Therefore, the relationship between neonatal outcomes and chorionicity could not be evaluated in this study and this is considered a limitation of the study.