Perinatal Deaths in Twin Pregnancy: A 22-Year Review

Abstract

Changes in the management of 1120 twin pregnancies delivered in Tampere University Central Hospital during the years 1964-1985 were studied, together with changes in the pattern of perinatal deaths. Perinatal mortality decreased from 7.4% in 1964-68 to 3.5% in 1981-85. There were no significant changes in stillbirths. The decrease of perinatal mortality resulted from a reduction in early neonatal deaths, mainly those due to respiratory distress syndrome. Changes in obstetric management include earlier diagnosis by ultrasound, intrapartum monitoring, and an increase in cesarean section rate from 4% to 32%. There is still a need for a reduction in the number of very early preterm births, and for more effective intrauterine supervision of twin pregnancies.

Monoamniotic twin pregnancies: antenatal management and perinatal results of 19 consecutive cases

“…Perinatal mortality is very high in our series, 12 cases in 38 births (or 32%), much higher than the 0.7% in the general pregnant population in France 16 . This perinatal mortality rate is similar to those reported by Lumme and Saarikoski 6 in their review (28–47%). However, it is much higher than that found in the other recent study of cases followed in a single centre (12%) 5 .…”

“…Perinatal mortality in MATP is high, with reported rates ranging from 28% to 70% in the studies before 2001 5 . The deaths are primarily related to prematurity and intrauterine fetal death due to cord accidents 5,6 …”

Perinatal mortality among twins and singletons in a city in southeastern Brazil, 1984-1996

“…Compared to singletons, the likelihood of stillbirths, early neonatal death and perinatal mortality among twins was 1.9, 6.5, and 4, respectively. These figures are consistent with data reported elsewhere (Osbourne and Patel, 1985;Papiernik et al, 1985;Doherty, 1988;Lumme and Saarikoski, 1988;Spellacy et al, 1990;Kiely, 1991;Fraser et al, 1991;Chen et al, 1992;Keith, 1994). The early neonatal death rate/stillbirth rate ratio among twins (2.9) was almost 2.5 times higher than that among singletons (1.2).…”

Complications of Twin Delivery and Associated Factors: A Hospital-Based Cross-Sectional Analytical Study in Yaoundé

“…There is increased risk of mal-pre-sentation and cord prolapse, and often cessation of labor during the expulsion of the 2nd twin, thus increasing the risk of acute fetal distress and need for instrumental extraction, obstetrical maneuvers and recourse to cesarean delivery [7]. Perinatal mortality is 3 to 7 times higher in twins compared to singletons due in particular to a higher occurrence of prematurity, hypotrophy and difficult delivery [9]. Monochorionic twins carry an additional risk owing to the twin-twin transfusion syndrome which occurs in 10% of cases [10].…”

“…Despite the low frequency of twin pregnancies, twins play a significant role in total perinatal mortality: 12.5% of perinatal deaths are due to twins in the United States. In England and Wales, in 1984, perinatal mortality in twin pregnancies was 42.8 per 1000 compared to 9.4 in singleton pregnancies [9]. Perinatal mortality, which is higher in African settings, is due to the fact that most of these women come from a weak socioeconomic background and they often start prenatal consultation at an advanced gestational age [10].…”