TY - JOUR
T1 - Perinatal outcomes of multiple-gestation pregnancies in Kenya, Zambia, Pakistan, India, Guatemala, and Argentina
T2 - A global network study
AU - Marete, Irene
AU - Tenge, Constance
AU - Pasha, Omrana
AU - Goudar, Shivaprasad
AU - Chomba, Elwyn
AU - Patel, Archana
AU - Althabe, Fernando
AU - Garces, Ana
AU - McClure, Elizabeth M.
AU - Saleem, Sarah
AU - Esamai, Fabian
AU - Kodkany, Bhala S.
AU - Belizan, Jose M.
AU - Derman, Richard J.
AU - Hibberd, Patricia L.
AU - Krebs, Nancy
AU - Buekens, Pierre
AU - Goldenberg, Robert L.
AU - Carlo, Waldemar A.
AU - Wallace, Dennis
AU - Moore, Janet
AU - Koso-Thomas, Marion
AU - Wright, Linda L.
AU - Liechty, Edward A.
PY - 2014/2
Y1 - 2014/2
N2 - Aim 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. Methods Pregnant women residing within defined geographic boundaries located in six countries were enrolled and followed to 42 days postpartum. Results 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. Conclusions 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.
AB - Aim 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. Methods Pregnant women residing within defined geographic boundaries located in six countries were enrolled and followed to 42 days postpartum. Results 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. Conclusions 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.
KW - developing countries
KW - multiples gestation
KW - perinatal mortality rate
KW - stillbirth
KW - twins
UR - http://www.scopus.com/inward/record.url?scp=84893695981&partnerID=8YFLogxK
U2 - 10.1055/s-0033-1338173
DO - 10.1055/s-0033-1338173
M3 - Article
C2 - 23512321
AN - SCOPUS:84893695981
SN - 0735-1631
VL - 31
SP - 125
EP - 132
JO - American Journal of Perinatology
JF - American Journal of Perinatology
IS - 2
ER -
