الفهرس 
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Abstract
A multiple fetal pregnancy’ is the term used when you are expecting two or more babies at the same time. It occurs in about one in 80 pregnancies for twins and one in 8000 pregnancies for triplets. Fertility treatment increases the chances of multiple pregnancy. The incidence of multiple pregnancies varies worldwide, twin pregnancy comprise an increasing portion of total pregnancies in developed world due to the expanded use of fertility treatments and older maternal age at childbirth. In the United States, twin births account for 3.3 percent of live births in 2011. Twins pregnancy accounts for 96 percent of multiple births in United States. Dizygotic twins are more common than monozygotic twins 69 and 31 percent of twins’ birth (respectively in the absence of use of assisted reproductive techniques “ART”). The incidence of monozygotic twins is relatively stable worldwide at 3 to 5 of 1000 births.
Multiple gestation is associated with higher rates of almost every potential complication of pregnancy, with the exceptions of postterm pregnancy and macrosomia. The most serious risk is spontaneous preterm delivery, which plays a major role in the increased perinatal mortality and shortterm and longterm morbidity observed in these infants. Higher rates of fetal growth restriction and congenital anomalies also contribute to adverse outcome in twin births. In addition, monochorionic (MC) twins are at risk for complications unique to these pregnancies, such as twintwin transfusion syndrome (TTTS), which can be lethal or associated with serious morbidity. Multiple-gestation pregnancies are associated with a significantly higher maternal complication rate than are singleton gestations. Multiple-gestation pregnancies carry an increased risk of hypertensive disorders of pregnancy; gestational diabetes mellitus; hyperemesis; preterm labor; premature rupture of membranes; anemia; placental abruption; postpartum hemorrhage; cardiac complications, such as myocardial infarction and left ventricular heart failure; operative deliveries, both vaginal and cesarean; required hysterectomy; and prolonged hospital stay.
The aim of this study is to assess the multiple fetal pregnancy deliveries (way of getting pregnant,gestational age at delivery, mode of delivery,the surgeon ranking, short term maternal and neonatal outcomes of twins,triplets and quadruplets) in Ain Shams Maternity Hospital during the period (January 2014- December 2016) in comparison with singleton pregnancies.
In this study, between 2014- 2016 our maternity hospital of Ain shams university managed 500 cases of multiple fetal pregnancies representing (1.3%) of total managed cases which are 33644, i.e.13 per 1000 births (1:76.9). We compared them to 500 cases of singleton pregnancies random cross sectional as control group for comparison with multiple fetal pregnancies. We collected the data from records of patients in the archive after taking permission from authorities and after ethical committee acceptance.
In our study, we compared the demographic data of the admitted cases of singleton pregnancies and multiple fetal pregnancies of each group alone. It was found that the age, duration of marriage and mode of conception were highly significant with p-values of <0.01, 0.001 and <0.01 respectively. We found that the maternal age with multiple fetal pregnancy was lower than in singletons. In our study, it was found that parity in multiple fetal pregnancy is lower than that for cases of singleton pregnancy with highly significant difference (p-value <0.01). Also, the gestational age at time of delivery was lower in multiple fetal pregnancy (32.17 ± 6.11) weeks than in singleton pregnancy (36.91 ± 3.81) weeks with highly significant difference (p-value< 0.01). This indicates that the incidence of preterm labor and delivery is more with multiple fetal pregnancies.
In the current study, we studied the causes of admission of both groups. The incidence of pre-eclampsia (PE), severe preeclampsia and eclampsia was higher with multiple fetal pregnancy (12.8%) than with singleton pregnancy (11.6%) but with no statistically significant difference (p-value=0.562). Malpresentations were higher with multiple fetal pregnancy (2.4%) but with no significant difference with p-value= 0.154. Also incidence of abortion was higher with multiple fetal pregnancy (6.8%) than singleton (0.8%) with highly significant difference with p-value <0.01. The antepartum hemorrhage found to be higher with multiple fetal pregnancy (5.6%), the difference was statistically significant with p-value=0.027. Incidence of rupture of membranes and rupture of uterus were higher with multiple fetal pregnancy and statistically significant with p-value of 0.012 and 0.045 respectively.
Medical diseases with pregnancy like cardiac diseases, gestational hypertension, cholestasis and acute fatty liver, systemic lupus erythematosis, epilepsy and thyroid diseases were same with both groups with no statistically significant difference. We found that the most common cause of admission is onset of labor then rupture of membrane then pre-eclampsia.
According to the mode of termination of pregnancy, we found that incidence of lower segment cesarean section (LSCS) (68%), hystrotomy, suction and evacuation (S&E) are higher with multiple fetal pregnancy with p-values of <0.01, 0.044 and <0.01 respectively. while spontaneous vaginal delivery (SVD) (16.4%) is lower in multiple fetal pregnancy with highly significant difference (p-value <0.01). The incidence of maternal mortality with multiple fetal pregnancy one case (0.2%) is equal to singletons 1 cases (0.2%), there was no statistically significant difference (p- value=1.00).
The cases of multiple fetal pregnancy needed to stay longer in the hospital than cases of singletons. The highly significant p value <0.01. There are cases of multiple fetal pregnancy whom needed blood transfusion more than singleton with highly significant p-value <0.01 Also maternal admission into intensive care unit (ICU) is higher because of associated preeclampsia, diseases with pregnancy and complications with highly significant p-value <0.01. The incidence of neonatal intensive care unit admission was higher with multiple fetal pregnancy with highly significant p-value <0.01. The congenital anomalies were higher with multiple fetal pregnancy (8%) which was highly significant in comparison with singletons with p-value <0.01. For neonates of multiple fetal pregnancy the apgar score of both 1 minute and 5 minutes were less than for those of singleton pregnancy. Also the birth weight of neonate of multiple fetal pregnancy was lower (2200gm) than that of singletons (3000gm) at time of delivery. The p-value for apgar score and birth weights were highly significant <0.01. As for fetal and neonatal deaths were more with multiple fetal pregnancy (22.4%) than singletons (4.8%) with highly significant p-value <0.01.