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Am J Perinatol. 2014 Feb;31(2):125-32. doi: 10.1055/s-0033-1338173. Epub 2013 Mar 19.

Perinatal outcomes of multiple-gestation pregnancies in Kenya, Zambia, Pakistan, India, Guatemala, and Argentina: a global network study.

Author information

1
Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya.
2
Department of Community Health Services, Aga Khan University, Karachi, Pakistan.
3
Jawaharlal Nehru Medical College, K.L.E. University, Karnataka, Belgaum, India.
4
University Teaching Hospital, Lusaka, Zambia.
5
Lata Medical Research Foundation, Maharashtra, Nagpur, India.
6
Institute for Clinical Effectiveness, Buenos Aires, Argentina.
7
Multidisciplinary Health Institute, Francisco Marroquin University, Guatemala City, Guatemala.
8
Research Triangle Institute International, Durham, North Carolina.
9
Christiana Care Health System, Wilmington, Delaware.
10
Divsion of Global Health, Massachusetts General Hospital, Boston, Massachusetts.
11
Department of Pediatrics, University of Colorado, Denver, Colorado.
12
School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana.
13
Columbia University, New York, New York.
14
Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.
15
National Institute of Child Health and Human Development, Bethesda, Maryland.
16
Department of Pediatrics, Riley Hospital, Indiana University, Indianapolis, Indiana.

Abstract

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.

PMID:
23512321
PMCID:
PMC4013719
DOI:
10.1055/s-0033-1338173
[Indexed for MEDLINE]
Free PMC Article

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