Risque foetal, perinatal et pronostic de la grossesse et de l\'accouchement gemellaires a la clinique de gynecologie et d\'obstetrique du cnhu de Cotonou,Benin: Etude rétrospective descriptive

Il s\'agissait de determiner la frequence des grossesses gemellaires, d\'analyser les risques obstetricaux, d\'etudier les indicateurs de morbidite et de mortalite et le pronostic. L\'etude retrospective descriptive cas-temoins etait menee sur une periode de 3 ans a la CUGO de Cotonou. L\'echantillon etait reparti en 249 grossesses gemellaires (cas) et 498 mono foetales (temoins). Les tests statistiques specifiques etaient utilises pour analyser les indicateurs de morbidite et le risque estime par le calcul de l\'Odds ratio(Or) et son intervalle de confiance (IC) a 95% en acceptant une probabilite p≤ 0,05. La frequence des grossesses gemellaires etait de 3,85%. Aux 1er et 2eme trimestres le risque de fausses couches spontanees etait multiplie par 4. Au troisieme trimestre le risque de syndrome vasculo- renal etait multiplie par 2 (Khi² = 34,96 ; Or= 2,47 ; IC : 1,87- 3,36 ; p= 0,000), celui de menace d\'accouchement premature par 4 (Khi² = 45,47 ; Or= 4,05 ; IC: 2,59 - 6,34 ; p= 0,000) et d\'hydramnios par 2. La morbidite foetale liee a la cesarienne etait due a la presentation vicieuse du premier jumeau avec un risque multiplie par pres de 15, le placenta praevia, la souffrance foetale aigue et l\'eclampsie dont le risque respectif etait multiplie par 9, 9 et 7. Le risque de deces maternel par hemorragie de la delivrance etait multiplie par 2. La morbidite neonatale etait dominee par la prematurite (p=0,048), le faible poids de naissance 8 fois plus eleve et un taux de mortalite perinatale multiplie par 3 par rapport aux temoins. L\'identification des risques lies a la gemellite est capitale d\'un double point de vue individuel et collectif dans le but d\'ameliorer les indicateurs de morbidite et de mortalite maternelles et neonatale. This study was aimed at determining the frequency of twin pregnancies, assessing obstetrical risks, morbidity and mortality, and outcome. It was a retrospective and descriptive case - control study over a 3 years period at the Gynecology and Obstetric clinic (CUGO) of the National Teaching Hospital in Cotonou. The study sample constituted 249 twin pregnancies (cases) and 498 singleton pregnancies (controls). Odds ratio (Or) and the confidence interval (CI) at 95% and considering a probability (p) d” 0.05 were used to study the correlation between morbidity indicators and estimated risk. The frequency of twin pregnancies was 3.85%. In the 1st and 2nd trimesters, the risk of spontaneous abortion was four times higher. In the third trimester the risk of a vascular-renal syndrome was twice higher (Khi² = 34.96 ; Or= 2.47 ; IC: 1.87 - 3,36 ; p = 0.000), the risk of premature childbirth four times (Khi² = 45.47; Or = 4.05 ; IC :2.59 – 6.34 ; p = 0.000) and that of hydramnios twice higher. Fetal morbidity from caesarean sections was due to abnormal presentation of the first twin (risk multiplied by 15), placenta praevia, neonatal asphyxia and eclampsia with a risk multiplied by 9, 9 and 7 respectively. The risk of maternal death from immediate post partum haemorrhage was multiplied by two. Neonatal morbidity was dominated by the prematurity (p=0.048), low weight birth (8 times higher), and a perinatal mortality rate 3 times higher than in the control group. We concluded that iidentification of risk factors associated with twin pregnancies is individually and collectively fundamental in order to reduce maternal and neonatal morbidity and mortality. Keywords : Twin pregnancy - Obstetrical risks - Outcome. Clinics in Mother and Child Health Vol. 4 (2) 2007 pp. 771-776