Determinants, incidence and perinatal outcomes of multiple pregnancy deliveries in a low-resource setting, Mpilo Central Hospital, Bulawayo, Zimbabwe

Mpilo Central Hospital is located in Bulawayo and deliveries 9000 deliveries per year. Bulawayo is the second largest city in Zimbabwe after the capital city Harare, with a population of 653, 337 as of the 2012 census.1 The unit receives referrals from urban and rural centres. It is located in Matabeleland, 439 km southwest of Harare, on the way to Victoria Falls. Multiple gestations are high risk pregnancies associated with significant poor perinatal outcomes compared to singletons.2 In lowand middle-income countries they pose a high risk to mothers due to inherent biological risks and scarcity of health resources.3 In low-resourced, Nigeria the incidence of twin gestation was found to be 2.3%, the highest in the world.4,5 The second twin is at greater risk of adverse perinatal outcome than the first twin.6 The second twin could die or suffer brain damage due to delayed delivery. Women with multiple gestations should have prompt recourse to emergency caesarean section to avoid poor fetal outcomes. Complications of multiple gestations include anaemia, preeclampsia/eclampsia and preterm labour. The women are at risk of postpartum haemorrhage and death. The fetal complications include twin-twin transfusion syndrome in monochromic twins, congenital malformations, intrauterine death, complications of prematurity, locked twins and birth asphyxia. Women with such high risk pregnancies should book early; have an early ultrasound for dating, fetal number and chorionicity. They should book in a centre where there is comprehensive emergency obstetric care. In low-resource settings, women carry such high risk pregnancies without access to such resources.