MULTIFETAL GESTATION-INCIDENCE AND RISK FACTORS

Dr. Mridula Singh and Dr. Sudha Chourasia Department of Obstetrics and Gynaecology, Atal Bihari Vajpayee Government Medical College, Vidisha, Madhya Pradesh, India. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 20 February 2020 Final Accepted: 22 March 2020 Published: April 2020

Recently, rate have increased because of advances in reproductive technology offsetting the naturally occurring rate decline and delayed child bearing. Factors influencing the frequency of dizygotic twining are maternal age, parity, race and ethnicity, conception soon after cessation of oral contraceptives, genetic predisposition and use of fertility enhancing therapies. Centre for Disease Control and prevention (CDC) defines more narrowly as any procedure that entails the handling of both eggs and sperm or of embryos for the purpose of establishing a pregnancy, more are the chances of multiple pregnancy.

Objective Of The Study:-
To know the incidence and risk factors associated with multifetal gestation. All antenatals admitted and delivered with multifetal gestation during the study period at Atal Bihari Vajpayee Government Medical College, Vidisha. Data is collected and entered using a predesigned proforma.
Detailed history was taken and recorded. History regarding months of amenorrhea, gestational age at presentation, menstrual history, family history of multiple pregnancy, history of infertility treatment and past obstetric history was noted.

Results:-
During the study period total number of deliveries were 6011 and 56 cases with multifetal gestation. Incidence of twins was 0.91% and triplets was 0.017%. There was 1 conjoint twin delivery. (Table 1) The incidence of twins was found to be maximum in age group 21-25 years (48.2%). (Table 2) The incidence was found higher among patients belonging to low socio-economic class (92.86%). (Table 3) The incidence was higher in patients from rural area (55.36%). (Table 4) The incidence was higher in multiparous patients as compared to prim gravida (59%). (Table 5) 8 patients had family history of multifetal pregnancy (14.3%), out of which 5 patients (8.9%) had history on mother's side and 3 patients (5.4%) had history on father's side. (Table 6) 11 patients (19.6%) out of 56 had history of ovulation induction while 5 patients (8.9%) had history of undergoing artificial reproduction therapy for infertility. (Table 7) The gestational age of presentation (by LMP) was <37 weeks(preterm) for 31 patients (55.36%) and >37 weeks (term) for 25 pateints (44.64%). (Table 8) Discussion:-Other research in India by Bhoraskar et al (1977) has reported incidence of twins as 1in 116 births, similar to our incidence of 1 in 109 births.
Hoestra et al (2008) (4) did not find the contribution of genetic variants in the overall incidence of twinning whereas in our study 8 cases (14.3%) had family history of twins.
In the present study 11 cases (19.6%) conceived after ovulation induction. The incidence of multifetal pregnancies when ovulation is induced is between 6.8 to 7%. (5) . Increased incidence in our study is due to increase in overall ovulation induction.

Conclusion:-
In this era where artificial reproduction therapy is making enormous progression, incidence of multifetal pregnancy is bound to increase. As we will see further advancement in this field we have to be prepared to handle and manage more number of multifetal pregnancy and problems associated with it. Also current elaborate research work shall be done with the aim to create a database for further comparison of future change in prevalence and trend of multifetal pregnancy.

Conflict of interest: None declared
Ethical approval: Not required