Document Detail


Determinants of perinatal mortality and serious neonatal morbidity in the second twin.
MedLine Citation:
PMID:  16946215     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To identify potential determinants of perinatal mortality and neonatal morbidity among second twins relative to first twins. METHODS: A retrospective cohort design was used to study twin deliveries in Nova Scotia from 1988 to 2002. Monoamniotic or conjoined twins and twin pairs with major congenital anomaly or antepartum fetal death of either twin were excluded. The primary outcome was a composite measure of perinatal mortality and neonatal morbidity, including birth asphyxia, respiratory distress, neonatal trauma, and infection. Risk of adverse outcome of second twins relative to first-born co-twins was determined by matched-pair analysis. RESULTS: Of 1,542 twin pairs, the second twin was at greater risk of composite adverse outcome (relative risk [RR] 1.62, 95% confidence interval [CI] 1.38-1.9) than the first twin. This excess risk was evident independent of presentation, chorionicity, or infant sex but was associated with planned vaginal delivery, birth weight discordance, and prolonged interdelivery interval. Term second twins were less likely to suffer excess morbidity with elective cesarean (RR 1.0, 95% CI 0.14-7.10) than with planned vaginal delivery (RR 3.0, 95% CI 1.47-6.11). The major contributors to neonatal morbidity in the second twin were birth asphyxia at 37 weeks or later and respiratory distress syndrome at less than 37 weeks. CONCLUSION: The second twin is at greater risk of adverse perinatal outcome than the first twin, independent of presentation, chorionicity, or infant sex. Planned vaginal delivery, birth weight discordance, and prolonged interdelivery interval increase this infant risk. Elective cesarean delivery at term may improve perinatal outcome for the second twin. However, the number of cesarean births required to prevent one case of composite adverse outcome, assuming causality, was 33.
Authors:
B Anthony Armson; Colleen O'Connell; Vidia Persad; K S Joseph; David C Young; Thomas F Baskett
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  108     ISSN:  0029-7844     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2006 Sep 
Date Detail:
Created Date:  2006-09-01     Completed Date:  2006-10-04     Revised Date:  2009-10-26    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  556-64     Citation Subset:  AIM; IM    
Affiliation:
Department of Obstetrics and Gynaecology and the Perinatal Epidemiology Research Unit, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada. anthony.armson@iwk.nshealth.ca
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MeSH Terms
Descriptor/Qualifier:
Adult
Asphyxia Neonatorum / mortality
Birth Order*
Birth Weight / physiology
Cesarean Section / methods,  mortality
Cohort Studies
Confidence Intervals
Delivery, Obstetric / methods,  mortality*
Female
Gestational Age
Humans
Infant Mortality*
Infant, Newborn
Male
Nova Scotia
Odds Ratio
Pregnancy
Pregnancy Outcome*
Respiratory Distress Syndrome, Newborn / mortality
Retrospective Studies
Risk Factors
Time Factors
Twins*

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


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