[Management of multiple pregnancies at the Befelatanana Antananarivo University Hospital Center (Madagascar): report of 143 cases].

Multiple pregnancies (MP) outcomes are often complicated. They deliver premature infants and provoke high blood pressure. A retrospective study was carried out in 1998 at the Maternity Hospital of Befelatanana, Antananarivo in order to assess MP frequency and to specify the most important favourising factors and difficulties during labor and the quality of the labor management. All pregnancies with a MP were included in this survey. 143 MP were registered: 142 twin pregnancies and 1 triplet pregnancy. 2.0 per cent of cases were recurrent MP. The average age of pregnancies was 26 years old. Among these 143 MP, 48.0 per cent were primiparas. Poor quality of prenatal visits is frequently encountered. As antecedents there are abortion, hormonal contraceptive taking, preterm delivery, gravidic toxemia, cicatricial uterus, ectopic pregnancy. 6.3 per cent of the first twin had breech presentation, 2.0 per cent transversal labor presentation. As events during labor 40.0 per cent dynamic dystocia, 26.0 per cent acute fetal suffering, 27.0 per cent hyperthermia, 23.0 per cent high blood pressure, some of them as eclampsia or pre-eclampsia were noted. 60.0 per cent of the first twin delivery were easy. Whatever his labor presentation, version by internal manipulations following by breech extraction was performed on the second twin (67.0 per cent of cases). 18.2 per cent of parturient women had cesaretomy. 11 maternal deaths were noted. Infant perinatal mortality rate was of 35.7 per cent. Infant morbidity and mortality are essentially due to infections. The authors conclude that complications prevention will be obtained by improvement of standard of living of all female able to procreate. It needs also correct cares at prenatal visits and during labor. Health education must be focalized on strict and correct surveillance of pregnancies and intergenesic periods by the reinforcement of planning family.