Multifetal pregnancies: preterm admissions and outcomes

Abstract

Objective. To describe the rates of antenatal hospital admission during twin or higher order multifetal pregnancies, and the admission outcomes as discharge undelivered, transfer to higher care, or spontaneous or elective delivery. Methods. Cohort study using linked birth and hospital data. The cohort comprised women who gave birth to twins or higher order multiple infants of ≥ 24 weeks gestation in 2001–2008 and who were admitted to hospital in weeks 20–36 of the pregnancy. Results. In 63.4% of 10 779 twin pregnancies and 99.5% of 197 triplet and quadruplet pregnancies, the woman was admitted to hospital at least once in weeks 20–36 of the pregnancy, for a total 10 985 admissions. Almost half the admissions (46.3%) ended in discharge without delivery, 10.7% in transfer to higher care, 21.1% in spontaneous labour and birth, and 21.8% in elective delivery (induction or prelabour Caesarean section). The reason for admission was preterm labour in 34.2% of admissions. Conclusions. Hospital admission during pregnancy is common for women with multifetal pregnancies, with many of these admissions resulting in preterm birth. This is the first study to report the rate of pregnancy admissions for women with multifetal pregnancies, and provides a baseline for future studies of hospital use in this population. What is known about the topic? Multifetal pregnancies are high risk and require greater medical care than singleton pregnancies. However, few studies specifically examine multifetal pregnancies, and most pregnancy studies exclude them, so there is little known about the resource use of this group. What does this paper add? This is the first paper to report population rates of hospital admission during pregnancy for women with multifetal pregnancies. We report the admission rates, and the admission outcomes as discharge undelivered, transfer to higher care or spontaneous or elective delivery. What are the implications for practitioners? Most women with multifetal pregnancies are admitted to hospital at least once during the pregnancy, with 51% of these admissions resulting in preterm delivery. Of those discharged undelivered, 60% were admitted for 1 day or less. This has implications for resource use, proposed place of birth and for practitioners advising pregnant women.