Abstract
Aim
To investigate perinatal mortality and morbidity rates of twin pregnancies and to determine the underlying factors responsible for the increase in these rates.
Methods
Records of 300 twin pregnancies which have been followed in our clinic between 1996 and 2005 were reviewed retrospectively. Perinatal mortality and morbidity rates, zygocity, chorionicity, gestational age at delivery, route of conception, birth weight, route of delivery, fetal gender and cesarean rates were investigated.
Results
A total of 16,549 deliveries have been reviewed and 2.9% (n = 484) of these were detected to be twin deliveries. Perinatal mortality, adjusted perinatal mortality, fetal loss, neonatal mortality and perinatal morbidity rates were 7.5, 6.9, 3, 5.8 and 15.4%, respectively. The principal causes of perinatal mortality were prematurity, fetal demise and congenital abnormalities. The main cause of morbidity was respiratory distress syndrome (RDS). In neonatal period 28% of newborns needed neonatal intensive care unit (NICU) and 12.1% received positive pressured ventilation (PPV). Perinatal mortality and morbidity rates were found to be independent from zygocity, instead they were closely linked with chorionicity. Perinatal mortality and morbidity were higher if maternal age was under 18 and over 35, and were not effected by intrauterine growth retardation (IUGR), discordance between twins or RDS prophylaxis.
Conclusion
Twin pregnancies have higher perinatal mortality and morbidity rates and potential obstetrical complications compared to singleton pregnancies, therefore should be monitored more intensely, appropriate precautions should be taken against obstetrical complications, especially before 31–32 weeks of gestation, deliveries should be performed in referral centers with competent NICUs.
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References
Kleinman JC, Fowler MG, Kessel SS (1991) Comparison of infant mortality among twins and singletons, United States, 1960 and 1983. Am J Epidemol 133:133–143
Pugliese A, Arsieri R, Patriarca V, Spagnolo A (1994) Incidence and neonatal mortality of twins, Italy, 1981–90. Acta Genet Med Gemellol 43:139–144
Smith-Levitin M, Skupski DW, Chervenak FA (1995) Multifetal pregnancies. Curr Opin Obstet Gynecol 7:465–471
Chitrit Y, Filidori M, Pons JC, Duyme M, Papiernik E (1999) Perinatal mortality in twin pregnancies: a 3-year analysis in Seine Saint-Denis (France). Europ J Obstet Gynecol Reprod Biol 86:23–28
Millar WJ, Wadhera S, Nimord C (1992) Multiple births, trends and patterns in Canada, 1974–1990. Health Rep 4:223–250
Russell RB, Petrini JR, Damus K, Mattison DR, Schwarz RH (2003) The changing epidemiology of multiple births in the United States. Obstet Gynecol 101:129–135
Martin JA, Hamilton BE, Menacker F, Sutton PD, Mathews TJ (2005) Births final data for 2003. Natl Vital Stat Rep 54(2):1–116
American College of Obstetricians and Gynecologists, Special problems of multiple gestations. Educational Bulletin No 253, ACOG, Washington DC, 1998
Lewi L, Lewi P, Diemert A, Jani J, Gucciardo L, Van Mieghem T et al (2008) The role of ultrasound examination in the first trimester and at 16 weeks’ gestation to predict fetal complications in monochorionic diamniotic twin pregnancies. Am J Obstet Gynecol 199(5):493.e1–7
Newman RB, Mauldin JG, Ebelling M (1999) Risk factors for neonatal death in twin gestations in the state of South Carolina. Am J Obstet Gynecol 180:757–762
Ibrahim SA, Babiker AG, Amin IK, Omer MI, Ruschuan H (1994) Factors associated with high risk of perinatal and neonatal mortality: an interim report on a prospective community-based study in rural Sudan. Paediatr Perinat Epidemiol 8(2):192–204
Rydhstom H (1990) The effects of maternal age parity and sex of the twins on twin perinatal mortality. A population based study. Acta Genet Med Gemellol 39(3):401
Moise J, Laor A (1998) The outcome of twin pregnancies after IVF. Hum Reprod 13:1702–1705
Lambalk C, Hooff M (2001) Natural versus induced twinning and pregnancy outcome: a Dutch nationwide survey of primiparous dizygotic twin deliveries. Fertil Steril 75:731–736
Olivennes F (1997) Kadhel. Perinatal outcome of twin pregnancies obtained after in vitro fertilization: comparison with twin pregnancies obtained spontaneously or after ovarian stimulation. Fertil Steril 66:105–109
Dhont M, De Neubourg F, Van der Elst J, De Sutter P et al (1997) Perinatal outcome of pregnancies after assisted reproduction: a case-control study. JARG 14(10):575–580
Helmerhorst FM, Perquin DA, Donker D, Keirse MJ (2004) Perinatal outcome of singletons and twins after assisted conception: a systematic review of controlled studies. Br Med J 328:261
Smith GC, Snah I, White IR, Pell JP, Dobbie R (2005) Mode of delivery and the risk of delivery-related perinatal death among twins at term: a retrospective cohort study of 8073 births. BJOG 112(8):1139–1144
Dube J, Dodds L, Amson A (2002) Does chorionicity or zigosity predict adverse perinatal outcomes in twins? Am J Obstet Gynecol 186:579–589
Chauhan SP, Scardo JA, Hayes E, Abuhamad AZ, Berghella V (2010) Twins: prevalence, problems, and preterm births. Am J Obstet Gynecol 203(4):305–315
Lee YM, Cleary-Goldman J, Thaker HM, Simpson LL (2006) Antenatal sonographic prediction of twin chorionicity. Am J Obstet Gynecol 195:863–867
Dias T, Arcangeli T, Bhide A, Napolitano R, Mahsud-Dornan S, Thilaganathan B (2011) First-trimester ultrasound determination of chorionicity in twin pregnancy. Ultrasound Obstet Gynecol. doi:10.1002/uog.8956 [Epub ahead of print]
Ortibus E, Lopriore E, Deprest J, Vandenbussche FP, Walther FJ, Diemert A (2009) The pregnancy and long-term neurodevelopmental outcome of monochorionic diamniotic twin gestations: a multicenter prospective cohort study from the first trimester onward. Am J Obstet Gynecol 200(5):494.e1-8
Smith NA, Wilkins-Haug L, Santolaya-Forgas J, Acker D, Economy KE, Benson CB (2010) Contemporary management of monochorionic diamniotic twins: outcomes and delivery recommendations revisited. Am J Obstet Gynecol 203(2):133.e1-6
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Gezer, A., Rashidova, M., Güralp, O. et al. Perinatal mortality and morbidity in twin pregnancies: the relation between chorionicity and gestational age at birth. Arch Gynecol Obstet 285, 353–360 (2012). https://doi.org/10.1007/s00404-011-1973-z
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DOI: https://doi.org/10.1007/s00404-011-1973-z