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Perinatal mortality and morbidity rates among singleton, twin, and triplet gestations.
MedLine Citation:
PMID:  10838344     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Objective: To determine rates of perinatal mortality and morbidity from 24 to 43 weeks gestation among singletons, twins, and triplets.Methods: Successfully linked data from 1992 Californian maternal and infant discharge records as well as birth and death certificates from acute care civilian hospitals were examined for perinatal mortality and morbidity. Perinatal mortality was defined as the sum of all stillbirths and neonatal deaths. Deliveries from 24 to 43 weeks gestation among singleton, twin, and triplet pregnancies were collected as separate data sets. Perinatal mortality was identified using birth certificate death indicators excluding deaths caused by congenital anomalies. Neonatal deaths were identified from death indicators found in the death certificates. For the purpose of this study, perinatal morbidities were identified by ICD-9 codes and limited to respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC). Perinatal mortality and morbidity rates were expressed as a percent of live births stratified by gestational age. Perinatal mortality data were expressed in log scale and perinatal morbidity rates were statistically compared.Results: There were 571,390 total births in California of which 527,677 (92%) were singleton, 12,535 (2%) were twin, and 367 (0.06%) were triplet gestations. Across gestation, the rate of RDS between triplets and twins was comparable (6.6% vs 6.8%). However, the rates of IVH and NEC were significantly greater in triplets than in twins (20% vs 8%, P <.0001, and 25% vs 9%, P <.0001, respectively). The perinatal mortality rates are shown below.Conclusions: Perinatal mortality rates were comparable among singleton, twin, and triplet gestations delivered between 24 and 30 weeks gestation. Unlike singletons and twins, the triplet perinatal mortality rate did not fall between 31 and 36 weeks gestation and remained at 2.6%. Twin perinatal mortality rate was equivalent to singletons until 36 weeks gestation. IVH and NEC were significantly greater among triplets regardless of gestational age. These data suggest that antepartum fetal surveillance of triplet pregnancies should start as early as 30 weeks gestation while testing for twin pregnancies can begin at 36 weeks gestation.
Authors:
Hedriana; Eby-Wilkens; Gilbert
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Publication Detail:
Type:  JOURNAL ARTICLE    
Journal Detail:
Title:  Primary care update for Ob/Gyns     Volume:  5     ISSN:  -     ISO Abbreviation:  Prim. Care Update Ob Gyns     Publication Date:  1998 Jul 
Date Detail:
Created Date:  2000-06-05     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9431228     Medline TA:  Prim Care Update Ob Gyns     Country:  -    
Other Details:
Languages:  ENG     Pagination:  184     Citation Subset:  -    
Affiliation:
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Davis Medical Center, California, Sacramento, USA
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