Document Detail

Birth order of twins and risk of perinatal death related to delivery in England, Northern Ireland, and Wales, 1994-2003: retrospective cohort study.
MedLine Citation:
PMID:  17337456     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To determine the effect of birth order on the risk of perinatal death in twin pregnancies.
DESIGN: Retrospective cohort study.
SETTING: England, Northern Ireland, and Wales, 1994-2003.
PARTICIPANTS: 1377 twin pregnancies with one intrapartum stillbirth or neonatal death from causes other than congenital abnormality and one surviving infant.
MAIN OUTCOME MEASURES: The risk of perinatal death in the first and second twin estimated with conditional logistic regression.
RESULTS: There was no association between birth order and the risk of death overall (odds ratio 1.0, 95% confidence interval 0.9 to 1.1). However, there was a highly significant interaction with gestational age (P<0.001). There was no association between birth order and the risk of death among infants born before 36 weeks' gestation but there was an increased risk of death among second twins born at term (2.3, 1.7 to 3.2, P<0.001), which was stronger for deaths caused by intrapartum anoxia or trauma (3.4, 2.2 to 5.3). Among term births, there was a trend (P=0.1) towards a greater risk of the second twin dying from anoxia among those delivered vaginally (4.1, 1.8 to 9.5) compared with those delivered by caesarean section (1.8, 0.9 to 3.6).
CONCLUSIONS: In this cohort, compared with first twins, second twins born at term were at increased risk of perinatal death related to delivery. Vaginally delivered second twins had a fourfold risk of death caused by intrapartum anoxia.
Gordon C S Smith; Kate M Fleming; Ian R White
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Publication Detail:
Type:  Journal Article     Date:  2007-03-02
Journal Detail:
Title:  BMJ (Clinical research ed.)     Volume:  334     ISSN:  1756-1833     ISO Abbreviation:  BMJ     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-03-16     Completed Date:  2007-03-26     Revised Date:  2014-02-19    
Medline Journal Info:
Nlm Unique ID:  8900488     Medline TA:  BMJ     Country:  England    
Other Details:
Languages:  eng     Pagination:  576     Citation Subset:  AIM; IM    
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MeSH Terms
Anoxia / mortality
Birth Order*
Delivery, Obstetric / mortality*
Gestational Age
Great Britain / epidemiology
Infant Mortality / trends
Infant, Newborn
Pregnancy, Multiple / statistics & numerical data*
Regression Analysis
Risk Factors
Stillbirth / epidemiology*
Grant Support
MC_U105260558//Medical Research Council
Comment In:
BMJ. 2007 Mar 31;334(7595):651-2   [PMID:  17395909 ]
BMJ. 2007 Mar 17;334(7593):545-6   [PMID:  17363782 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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