Impact of prenatal management of multiple pregnancies on perinatal outcomes A five-year observational single-center study.
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Abstract
Introduction: The study focused on prenatal care and its relationship with perinatal outcomes in multiple pregnancies at the Gynecological, Obstetric, and Pediatric University Hospital of Guayaquil. A total of 266 multiple pregnancies concluded at the institution were analyzed out of 429 cases received between January 2017 and June 2021.
Methods: We conducted a quantitative, non-experimental, descriptive, correlational, retrospective investigation, analyzing prenatal care in multiple pregnancies and its relationship to fetal, perinatal, and neonatal morbidity and mortality at the hospital. We received 429 multiple pregnancies between January 2017 and June 2021. We studied only the 266 cases that concluded their multiple gestation at the institution, regardless of chronicity, identified through the statistics department, operating room, certificates of live births (REVIT), and delivery room, excluding the 163 cases that did not conclude the pregnancy at the hospital.
Results: It was found that 49.6% of the patients received a minimum of 5 prenatal consultations, with an average of 1.58 consultations. Additionally, a significant correlation (p=0.021) was observed between gestational age and receiving prenatal care at the institution, with 58% of preterm cases having no prenatal care and maternal ages between 18 and 35 years more prone to prematurity (p=0.036). On the other hand, it was found that 78.7% of cases where chorionicity was not defined did not receive any ultrasound at the institution, and it was diagnosed in only 51.5% of cases. Chorionicity did not show a statistically significant influence on admission or length of stay in the neonatal intensive care unit nor on mortality (p=0.561, p=0.487, p=0.429). However, the performance of ultrasounds, admission, and length of stay in the neonatal intensive care unit showed a statistically significant relationship with the number of deaths (P=0.0001) in all cases.
Conclusions: Patients with multiple pregnancies receive four times fewer prenatal care visits than recommended, which, combined with insufficient prenatal ultrasound diagnosis, leads to contradictory perinatal management and higher rates of prematurity, admission, and mortality in the neonatal intensive care unit.
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