The Importance of Specialised Care for Multiple Pregnancies
Maternal healthcare experts have highlighted the critical need for women carrying multiple pregnancies to register for antenatal care and deliver in well-equipped tertiary health facilities, teaching hospitals, or specialist hospitals. This is essential to reduce the risk of maternal and neonatal deaths. These high-risk pregnancies are more likely to result in complications such as preeclampsia, anaemia, postpartum haemorrhage, premature delivery, and twin-to-twin transfusion syndrome.
Experts have stated that specialist, tertiary, and doctor-led hospitals possess the necessary resources to manage these complications effectively. In exclusive interviews with PUNCH Healthwise, gynaecologists emphasized that appropriate facilities must have obstetricians, fetal medicine specialists, neonatologists, neonatal intensive care units, emergency surgery capacity, blood banking systems, and advanced monitoring equipment to ensure safe delivery and care for both mother and babies.
Risks of Delivering in Poorly Equipped Facilities
Delivering in poorly equipped facilities can lead to delayed diagnosis of complications, lack of emergency intervention, poor outcomes, and increased risks of maternal and neonatal deaths. Specialists reiterated that multiple pregnancies, including twins, triplets, quadruplets, quintuplets, and above, require specialised care. Early registration in appropriate facilities improves the chances of detecting complications on time, planning a safe delivery, and preventing avoidable deaths.
A recent case in Kano involved a woman who gave birth to quintuplets—three boys and two girls—who later died from persistent bleeding. Nigeria accounts for 34 per cent of global maternal deaths, driven by factors such as severe bleeding, infection, hypertensive disorders of pregnancy, obstructed labour, anaemia, and unsafe abortions.
Expert Insights on Managing High-Risk Pregnancies
Commenting on the matter, a Professor of Obstetrics and Gynaecology at Usmanu Danfodiyo University, Sokoto, Abubakar Panti, described multiple pregnancies as a condition where a woman carries more than one baby, which could involve twins, triplets, or more. He stressed that such pregnancies should be registered and managed in tertiary hospitals, meaning teaching hospitals, specialised maternity centres, or well-equipped tertiary health facilities like Federal Medical Centres.
Panti added that it could also be a secondary healthcare facility, such as general hospitals that are well-equipped and well-staffed, or some private clinics with very good facilities and the full complement of staff. These facilities should have obstetricians, fetal medicine specialists, neonatologists, and access to neonatal intensive care units because the majority of these pregnancies result in preterm delivery.
Essential Resources for Safe Delivery
The specialist explained that such centres must also have emergency surgical services, including caesarean sections with the full complement of theatre staff, anaesthetists, and surgeons, functional blood banks, and advanced monitoring equipment. A multiple pregnancy is a high-risk pregnancy prone to problems during pregnancy and delivery, and therefore, they should be managed and delivered in the aforementioned facilities.
It is essential that these centres can provide expert monitoring of this pregnancy to detect complications early because they can have complications like preeclampsia, which can progress to eclampsia if not addressed. They are also prone to anaemia, placenta problems, abnormal positioning of babies, and postpartum haemorrhage. Prematurity, low birth weight, and increased perinatal mortality are additional concerns.
Advanced Equipment and Emergency Readiness
The professor noted that facilities should have advanced equipment, such as ultrasound scans and fetal monitoring, which will help track the babies’ development and growth. There should be emergency readiness, with quick response available if complications arise during pregnancy or labour. Tertiary hospitals are preferable as specialists are available 24/7, from resident doctors to senior registrars and consultants.
Panti stated that such women need multidisciplinary care, adding that they should have access to obstetricians, paediatricians, anaesthetists, and surgeons in one place. He warned that pregnant women with multiple pregnancies who fail to register in appropriate facilities risk delayed diagnosis of complications, lack of emergency intervention, and poor outcomes.
Additional Complications and Recommendations
The fertility expert added that women with multiple pregnancies often deliver prematurely and should give birth in facilities with well-equipped neonatal intensive care units to reduce the risk of neonatal deaths. Other complications include twin-to-twin transfusion syndrome in identical twins sharing the same placenta, birth asphyxia if delivery is not conducted by a skilled obstetrician, and a higher risk of stillbirth and neonatal death.
Panti advised that once a woman misses her period, she should first undergo a serum pregnancy test, adding that two to three weeks later, an ultrasound scan should be carried out to determine the number of foetuses and guide the choice of facility for antenatal registration and delivery.
Expert Advice on Choosing the Right Facility
A Professor of Obstetrics and Gynaecology at Obafemi Awolowo University, Ile-Ife, Ernest Orji, stated that women with multiple pregnancies should receive care and deliver in doctor-manned healthcare facilities with maternity services, 24-hour emergency access, and blood transfusion services. When discussing multiple pregnancies, he said it means two or more, making them high-risk pregnancies that must be registered in appropriate facilities.
Orji noted that while teaching or specialist hospitals are preferable, many women in Nigeria may not have access to them. Therefore, a doctor-manned healthcare facility with the capacity to handle emergencies is also suitable. He warned that many women still seek care in poorly equipped centres due to poverty, ignorance, and other factors, increasing their risk of complications.
He emphasized that early antenatal registration helps determine the number of babies, identify risk factors, and plan delivery appropriately. The more the number of babies, the higher the risk. Early registration allows doctors to detect complications such as hypertension, bleeding, or low-lying placenta and manage them promptly.
Orji added that multiple pregnancies are associated with an increased risk of severe bleeding, hypertension, and premature birth, stressing that access to skilled care could significantly improve outcomes. If problems are detected early, they can be treated or referred on time. However, many patients present late when complications have worsened, contributing to maternal and neonatal deaths.
