Women pregnant with twins must start antenatal early –Gynaecologist

A Senior Registrar in the Obstetrics and Gynaecology Department at the Aminu Kano Teaching Hospital, Kano State, Dr. Mahmoud Magashi, has urged women pregnant with twins to start antenatal early.

Besides starting antenatal early, Magashi says it is also crucial for the women to deliver in the hospital under the care and supervision of skilled birth attendants in order to effectively manage the risks associated with multiple births.

According to him, women pregnant with twins or more babies require more care, stressing that twin gestation is a high-risk pregnancy.

The obstetrician and gynaecologist made the appeal during an exclusive interview with PUNCH HealthWise, revealing that twin gestation is a risk factor for postpartum hemorrhage which, in turn, is the leading cause of maternal mortality worldwide if it is not well managed.

“Twin gestation is a high-risk pregnancy. It is a high risk pregnancy in the sense that it is associated with so many complications.

“Consequently, women that are carrying twin pregnancy should ensure that they start antenatal early and also ensure they deliver in the hospital.

“The delivery of twins has its own risk and the woman is at risk of having postpartum hemorrhage.

“Though twin gestation is not one of the causes of maternal mortality, it is a risk factor for postpartum hemorrhage and the bleeding is the leading cause of maternal mortality worldwide,” Magashi noted.

According to the World Health Organisation, in 2015, Nigeria’s estimated maternal mortality ratio was over 800 maternal deaths per 100,000 live births, with approximately 58,000 maternal deaths during that year.

But the Demographic and Health Survey 2018 showed that Nigeria’s latest maternal mortality ratio is 512 per 100,000 live births, which experts say is still very high.

Listing the various complications associated with twin gestation, Magashi said the situation could be effectively managed through combined efforts, emphasising that women pregnant with more than one baby require special care and attention.

“She requires more care because if it is twins, you are talking of two foetuses. So, right from her first trimester, you find out that their own early pregnancy symptoms are higher.

“The symptoms are more severe in a woman carrying multiple gestation. So, even the vomiting may be severe. She will have excessive vomiting and the risk of having miscarriages is higher in twins than in singletons.

“As the pregnancy progresses, there will be increase in special symptoms as she will be complaining of excessive heaviness of the tummy.

“If it is twin gestation, she is at risk of anaemia in pregnancy. If the woman has anaemia, the baby may have intrauterine growth restriction.

“Women with twin gestation may deliver pre-term because they are at risk of that. They are also at risk of placenta previa which predisposes them to antepartum haemorrhage [bleeding from or into the genital tract during pregnancy].

“Again, they are at risk of having premature rupture of the membrane and also at risk of having hypertensive diseases of pregnancy which include severe preeclampsia and eclampsia,” the physician added.

On the reasons why women with multiple gestation are at risk of miscarriage, he added, “They at risk of having chromosomal abnormality – genetics abnormality. If they have this at the beginning of the pregnancy, there is the tendency that they will miscarry the babies.”

According to him, there are so many predisposing factors that make women to have multiple gestation.

“Age contributes to multiple gestation, use of ovulation induction medication, assisted reproductive techniques and history of twins in the family,” he said.

He cautioned that if the complications associated with twin gestation are not well managed, it could lead to the death of the woman.

Studies also show that twin pregnancy remains a high-risk pregnancy with high caesarean section rate, high perinatal mortality [the number of foetal deaths], and high foetal, neonatal and maternal morbidity.

Experts , however, say majority of causes and contributory factors to reported maternal deaths in Nigeria are preventable through combined safe motherhood strategies of focused antenatal care, prompt referral, active management of labour and access to family planning.