Abstract:
Aim To determine the rates of multiple gestation, stillbirth, and perinatal and neonatal
mortality and to determine health care system characteristics related to perinatal mortality
of these pregnancies in low- and middle-income countries.
Methods Pregnant women residing within defined geographic boundaries located in six
countries were enrolled and followed to 42 days postpartum.
Results Multiple gestations were 0.9% of births. Multiple gestations were more likely to
deliver in a health care facility compared with singletons (70 and 66%, respectively,p < 0.001), to be attended by skilled health personnel (71 and 67%, p < 0.001), and to be
delivered by cesarean (18 versus 9%, p < 0.001). Multiple-gestation fetuses had a relative risk
(RR) for stillbirth of 2.65 (95% confidence interval [CI] 2.06, 3.41) and for perinatal mortality
rate (PMR) a RR of 3.98 (95% CI 3.40, 4.65) relative to singletons (both p < 0.0001). Neither
delivery in a health facility nor the cesarean delivery rate was associated with decreased PMR.
Among multiple-gestation deliveries, physician-attended delivery relative to delivery by other
health providers was associated with a decreased risk of perinatal mortality.
Conclusions Multiple gestations contribute disproportionately to PMR in low-resource
countries. Neither delivery in a health facility nor the cesarean delivery rate is associated with
improved PMR
