Document Detail


Birth order, gestational age, and risk of delivery related perinatal death in twins: retrospective cohort study.
MedLine Citation:
PMID:  12411358     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine whether twins born second are at increased risk of perinatal death because of complications during labour and delivery.
DESIGN: Retrospective cohort study.
SETTING: Scotland, 1992 and 1997.
PARTICIPANTS: All twin births at or after 24 weeks' gestation, excluding twin pairs in which either twin died before labour or delivery or died during or after labour and delivery because of congenital abnormality, non-immune hydrops, or twin to twin transfusion syndrome.
MAIN OUTCOME MEASURE: Delivery related perinatal deaths (deaths during labour or the neonatal period).
RESULTS: Overall, delivery related perinatal deaths were recorded for 23 first twins only and 23 second twins only of 1438 twin pairs born before 36 weeks (preterm) by means other than planned caesarean section (P>0.99). No deaths of first twins and nine deaths of second twins (P=0.004) were recorded among the 2436 twin pairs born at or after 36 weeks (term). Discordance between first and second twins differed significantly in preterm and term births (P=0.007). Seven of nine deaths of second twins at term were due to anoxia during the birth (2.9 (95% confidence interval 1.2 to 5.9) per 1000); five of these deaths were associated with mechanical problems with the second delivery following vaginal delivery of the first twin. No deaths were recorded among 454 second twins delivered at term by planned caesarean section.
CONCLUSIONS: Second twins born at term are at higher risk than first twins of death due to complications of delivery. Previous studies may not have shown an increased risk because of inadequate categorisation of deaths, lack of statistical power, inappropriate analyses, and pooling of data about preterm births and term births.
Authors:
Gordon C S Smith; Jill P Pell; Richard Dobbie
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Publication Detail:
Type:  Journal Article; Twin Study    
Journal Detail:
Title:  BMJ (Clinical research ed.)     Volume:  325     ISSN:  1756-1833     ISO Abbreviation:  BMJ     Publication Date:  2002 Nov 
Date Detail:
Created Date:  2002-11-04     Completed Date:  2002-11-21     Revised Date:  2012-03-06    
Medline Journal Info:
Nlm Unique ID:  8900488     Medline TA:  BMJ     Country:  England    
Other Details:
Languages:  eng     Pagination:  1004     Citation Subset:  AIM; IM    
Affiliation:
Department of Obstetrics and Gynaecology, Rosie Maternity Hospital, Cambridge CB2 2QQ. gcss2@cam.ac.uk
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MeSH Terms
Descriptor/Qualifier:
Birth Order*
Cohort Studies
Death, Sudden / etiology*
Delivery, Obstetric / adverse effects*
Female
Fetal Death / etiology*
Humans
Infant, Newborn
Logistic Models
Multivariate Analysis
Obstetric Labor Complications*
Pregnancy
Pregnancy, Multiple
Regression Analysis
Retrospective Studies
Risk Factors
Scotland
Twins
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