Perinatal mortality in twin deliveries in a general hospital in Zambia.

Data from birth records and death certificates were used retrospectively to determine the risk factors associated with perinatal mortality in twin pregnancy at Mansa General Hospital between 1 August 1993 and 31 July 1995. A total of 3091 singleton births, 128 sets of twins, and three sets of triplets was recorded during the study period with a twinning rate of 4 per cent of the total deliveries. Perinatal mortality in twin gestation was high (141/1000) and affected mostly the second twin (72 per cent). The main risk factors associated with perinatal mortality in twin pregnancy were birthweight less than 2000 g (47 per cent), retained second twin (36 per cent), primiparity (28 per cent), fetal malpresentations (25 per cent), cord anomalies (17 per cent), and home deliveries (14 per cent). Perinatal deaths in twin pregnancies can be reduced by early recognition of twin gestation during antenatal visits, prevention of premature labour, and provision for emergency referral. A woman carrying twins should be advised to deliver in a well equipped health facility, with adequately trained health personnel rather than the traditional midwife, in order to minimize associated hazards.