Skip to main content
NCBI home page
Bulletin of the New York Academy of Medicine logoLink to Bulletin of the New York Academy of Medicine
. 1990 Nov-Dec;66(6):618–637.

The epidemiology of perinatal mortality in multiple births.

J L Kiely 1
PMCID: PMC1809788  PMID: 2282443

Abstract

The epidemiology of perinatal mortality in multiple pregnancies was investigated from data on 16,831 multiple births from New York City's computerized vital records for 1978-1984. Twins had a sixfold higher rate of neonatal death and a threefold higher rate of fetal death during labor than had singleton infants. Much of this excess mortality can be explained by the lower birthweight distribution in twins: between 1,001 and 2,500 grams twins had birthweight-specific death rates equivalent to or substantially less than singletons. However, in infants of normal birthweights, twins had more than three times the mortality risk of singletons. For twins in vertex presentation between 1,001 and 3,000 grams, cesarean section did not appreciably reduce neonatal mortality risk. For twins in vertex presentation who weighted more than 3,000 grams the neonatal mortality rate was more than four times higher in vaginal deliveries than in cesarean sections (exact p = 0.034). Efforts to prevent intrapartum and neonatal mortality in multiple births should aim at reducing the incidence of low birthweight twins. More research is needed on the etiology of perinatal problems in normal birthweight twins (greater than or equal to 2,501 grams), especially on the effects of different modes of delivery.

Full text

PDF
618

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ahmed A. G., Klopper A. Estimation of gestational age by last menstrual period, by ultrasound scan and by SP1 concentration: comparisons with date of delivery. Br J Obstet Gynaecol. 1986 Feb;93(2):122–127. doi: 10.1111/j.1471-0528.1986.tb07876.x. [DOI] [PubMed] [Google Scholar]
  2. BABSON S. G., KANGAS J., YOUNG N., BRAMHALL J. L. GROWTH AND DEVELOPMENT OF TWINS OF DISSIMILAR SIZE AT BIRTH. Pediatrics. 1964 Mar;33:327–333. [PubMed] [Google Scholar]
  3. Battaglia F. C., Frazier T. M., Hellegers A. E. Birth weight, gestational age, and pregnancy out- come, with special reference to high birth weight-low gestational age infant. Pediatrics. 1966 Mar;37(3):417–422. [PubMed] [Google Scholar]
  4. Bleker O. P., Breur W., Huidekoper B. L. A study of birth weight, placental weight and mortality of twins as compared to singletons. Br J Obstet Gynaecol. 1979 Feb;86(2):111–118. doi: 10.1111/j.1471-0528.1979.tb10577.x. [DOI] [PubMed] [Google Scholar]
  5. Botting B. J., Davies I. M., Macfarlane A. J. Recent trends in the incidence of multiple births and associated mortality. Arch Dis Child. 1987 Sep;62(9):941–950. doi: 10.1136/adc.62.9.941. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Brand R., Keirse M. J. Using logistic regression in perinatal epidemiology: an introduction for clinical researchers. Part 1: Basic concepts. Paediatr Perinat Epidemiol. 1990 Jan;4(1):22–38. doi: 10.1111/j.1365-3016.1990.tb00615.x. [DOI] [PubMed] [Google Scholar]
  7. Buekens P., Lagasse R., Puissant F., Leroy F. Do breech presentations in twins and singletons run different risks? Acta Genet Med Gemellol (Roma) 1985;34(3-4):207–211. doi: 10.1017/s000156600000475x. [DOI] [PubMed] [Google Scholar]
  8. Chervenak F. A., Johnson R. E., Youcha S., Hobbins J. C., Berkowitz R. L. Intrapartum management of twin gestation. Obstet Gynecol. 1985 Jan;65(1):119–124. [PubMed] [Google Scholar]
  9. Chervenak F. A. The controversy of mode of delivery in twins: the intrapartum management of twin gestation (Part II). Semin Perinatol. 1986 Jan;10(1):44–49. [PubMed] [Google Scholar]
  10. Clarkson J. E., Buckfield P. M., Herbison G. P. The outcome of twin pregnancies in Dunedin 1968-1978. Aust N Z J Obstet Gynaecol. 1982 Aug;22(3):127–130. doi: 10.1111/j.1479-828x.1982.tb01424.x. [DOI] [PubMed] [Google Scholar]
  11. Crane J. P., Tomich P. G., Kopta M. Ultrasonic growth patterns in normal and discordant twins. Obstet Gynecol. 1980 Jun;55(6):678–683. [PubMed] [Google Scholar]
  12. David R. J. Population-based intrauterine growth curves from computerized birth certificates. South Med J. 1983 Nov;76(11):1401–1406. doi: 10.1097/00007611-198311000-00020. [DOI] [PubMed] [Google Scholar]
  13. David R. J. The quality and completeness of birthweight and gestational age data in computerized birth files. Am J Public Health. 1980 Sep;70(9):964–973. doi: 10.2105/ajph.70.9.964. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Delke I., Hyatt R., Feinkind L., Minkoff H. Avoidable causes of perinatal death at or after term pregnancy in an inner-city hospital: medical versus social. Am J Obstet Gynecol. 1988 Sep;159(3):562–566. doi: 10.1016/s0002-9378(88)80008-5. [DOI] [PubMed] [Google Scholar]
  15. Fabre E., González de Agüero R., de Agustin J. L., Pérez-Hiraldo M. P., Bescos J. L. Perinatal mortality in twin pregnancy: an analysis of birth weight-specific mortality rates and adjusted mortality rates for birth weight distributions. J Perinat Med. 1988;16(2):85–91. doi: 10.1515/jpme.1988.16.2.85. [DOI] [PubMed] [Google Scholar]
  16. Ghai V., Vidyasagar D. Morbidity and mortality factors in twins. An epidemiologic approach. Clin Perinatol. 1988 Mar;15(1):123–140. [PubMed] [Google Scholar]
  17. Goldenberg R. L., Cutter G. R., Hoffman H. J., Foster J. M., Nelson K. G., Hauth J. C. Intrauterine growth retardation: standards for diagnosis. Am J Obstet Gynecol. 1989 Aug;161(2):271–277. doi: 10.1016/0002-9378(89)90497-3. [DOI] [PubMed] [Google Scholar]
  18. Grothe W., Rüttgers H. Twin pregnancies: an 11-year review. Acta Genet Med Gemellol (Roma) 1985;34(1-2):49–58. doi: 10.1017/s0001566000004918. [DOI] [PubMed] [Google Scholar]
  19. Gruenwald P. Environmental influences on twins apparent at birth. A preliminary study. Biol Neonate. 1970;15(12):79–93. doi: 10.1159/000240213. [DOI] [PubMed] [Google Scholar]
  20. Haines C. J., Langlois S. L., Jones W. R. Ultrasonic measurement of fetal femoral length in singleton and twin pregnancies. Am J Obstet Gynecol. 1986 Oct;155(4):838–841. doi: 10.1016/s0002-9378(86)80034-5. [DOI] [PubMed] [Google Scholar]
  21. Ho S. K., Wu P. Y. Perinatal factors and neonatal morbidity in twin pregnancy. Am J Obstet Gynecol. 1975 Aug 15;122(8):979–987. doi: 10.1016/0002-9378(75)90360-9. [DOI] [PubMed] [Google Scholar]
  22. Hoffman H. J., Bakketeig L. S., Stark C. R. Twins and perinatal mortality: a comparison between single and twin births in Minnesota and in Norway, 1967--1973. Prog Clin Biol Res. 1978;24(Pt B):133–142. [PubMed] [Google Scholar]
  23. Ismajovich B., Confino E., Sherzer A., Lidor A., David M. P. Optimal delivery of nonvertex twins. Mt Sinai J Med. 1985 Feb;52(2):106–109. [PubMed] [Google Scholar]
  24. Keith L., Ellis R., Berger G. S., Depp R. The Northwestern University multihospital twin study. I. A description of 588 twin pregnancies and associated pregnancy loss, 1971 to 1975. Am J Obstet Gynecol. 1980 Dec 1;138(7 Pt 1):781–789. [PubMed] [Google Scholar]
  25. Kiely J. L., Paneth N., Susser M. An assessment of the effects of maternal age and parity in different components of perinatal mortality. Am J Epidemiol. 1986 Mar;123(3):444–454. doi: 10.1093/oxfordjournals.aje.a114259. [DOI] [PubMed] [Google Scholar]
  26. Kiely J. L., Paneth N., Susser M. Fetal death during labor: an epidemiologic indicator of level of obstetric care. Am J Obstet Gynecol. 1985 Dec 1;153(7):721–727. doi: 10.1016/0002-9378(85)90331-x. [DOI] [PubMed] [Google Scholar]
  27. Kramer M. S., McLean F. H., Boyd M. E., Usher R. H. The validity of gestational age estimation by menstrual dating in term, preterm, and postterm gestations. JAMA. 1988 Dec 9;260(22):3306–3308. [PubMed] [Google Scholar]
  28. Laros R. K., Jr, Dattel B. J. Management of twin pregnancy: the vaginal route is still safe. Am J Obstet Gynecol. 1988 Jun;158(6 Pt 1):1330–1338. doi: 10.1016/0002-9378(88)90364-x. [DOI] [PubMed] [Google Scholar]
  29. Leroy B., Lefort F., Neveu P., Risse R. J., Trévise P., Jeny R. Intrauterine growth charts for twin fetuses. Acta Genet Med Gemellol (Roma) 1982;31(3-4):199–206. doi: 10.1017/s0001566000008291. [DOI] [PubMed] [Google Scholar]
  30. Leveno K. J., Santos-Ramos R., Duenhoelter J. H., Reisch J. S., Whalley P. J. Sonar cephalometry in twins: a table of biparietal diameters for normal twin fetuses and a comparison with singletons. Am J Obstet Gynecol. 1979 Nov 15;135(6):727–730. doi: 10.1016/0002-9378(79)90382-x. [DOI] [PubMed] [Google Scholar]
  31. MCKEOWN T., RECORD R. G. Observations on foetal growth in multiple pregnancy in man. J Endocrinol. 1952 Oct;8(4):386–401. doi: 10.1677/joe.0.0080386. [DOI] [PubMed] [Google Scholar]
  32. Mazor M., Leiberman J. R., Dreval D., Wiznitzer A., Alyagon A., Insler V. Management and outcome of vertex-breech and vertex-vertex presentation in twin gestation: a comparative study. Eur J Obstet Gynecol Reprod Biol. 1986 Jun;22(1-2):69–75. doi: 10.1016/0028-2243(86)90091-2. [DOI] [PubMed] [Google Scholar]
  33. McCarthy B. J., Sachs B. P., Layde P. M., Burton A., Terry J. S., Rochat R. The epidemiology of neonatal death in twins. Am J Obstet Gynecol. 1981 Oct 1;141(3):252–256. doi: 10.1016/s0002-9378(16)32628-x. [DOI] [PubMed] [Google Scholar]
  34. Naeye R. L., Benirschke K., Hagstrom J. W., Marcus C. C. Intrauterine growth of twins as estimated from liveborn birth-weight data. Pediatrics. 1966 Mar;37(3):409–416. [PubMed] [Google Scholar]
  35. Notzon F. C. International differences in the use of obstetric interventions. JAMA. 1990 Jun 27;263(24):3286–3291. [PubMed] [Google Scholar]
  36. Osbourne G. K., Patel N. B. An assessment of perinatal mortality in twin pregnancies in Dundee. Acta Genet Med Gemellol (Roma) 1985;34(3-4):193–199. doi: 10.1017/s0001566000004736. [DOI] [PubMed] [Google Scholar]
  37. Rabinovici J., Barkai G., Reichman B., Serr D. M., Mashiach S. Randomized management of the second nonvertex twin: vaginal delivery or cesarean section. Am J Obstet Gynecol. 1987 Jan;156(1):52–56. doi: 10.1016/0002-9378(87)90201-8. [DOI] [PubMed] [Google Scholar]
  38. Rosen M. G., Chik L. The association between cesarean birth and outcome in vertex presentation: relative importance of birth weight, Dubowitz scores, and delivery route. Am J Obstet Gynecol. 1984 Nov 15;150(6):775–779. doi: 10.1016/0002-9378(84)90684-7. [DOI] [PubMed] [Google Scholar]
  39. Rosen M. G., Chik L. The effect of delivery route on outcome in breech presentation. Am J Obstet Gynecol. 1984 Apr 1;148(7):909–914. doi: 10.1016/0002-9378(84)90533-7. [DOI] [PubMed] [Google Scholar]
  40. Schneider L., Bessis R., Tabaste J. L., Sarramond M. F., Papiernik E., Baudet J., Pontonnier G. Echographic survey of twin fetal growth: a plea for specific charts for twins. Prog Clin Biol Res. 1978;24(Pt 100):137–141. [PubMed] [Google Scholar]
  41. Secher N. J., Kaern J., Hansen P. K. Intrauterine growth in twin pregnancies: prediction of fetal growth retardation. Obstet Gynecol. 1985 Jul;66(1):63–68. [PubMed] [Google Scholar]
  42. Socol M. L., Tamura R. K., Sabbagha R. E., Chen T., Vaisrub N. Diminished biparietal diameter and abdominal circumference growth in twins. Obstet Gynecol. 1984 Aug;64(2):235–238. [PubMed] [Google Scholar]
  43. Spellacy W. N., Handler A., Ferre C. D. A case-control study of 1253 twin pregnancies from a 1982-1987 perinatal data base. Obstet Gynecol. 1990 Feb;75(2):168–171. [PubMed] [Google Scholar]
  44. Stefos T., Deter R. L., Hill R. M., Simon N. V. Individual growth curve standards in twins: prediction of third-trimester growth and birth characteristics. Am J Obstet Gynecol. 1989 Jul;161(1):179–183. doi: 10.1016/0002-9378(89)90261-5. [DOI] [PubMed] [Google Scholar]
  45. Thompson S. A., Lyons T. L., Makowski E. L. Outcomes of twin gestations at the University of Colorado Health Sciences Center, 1973-1983. J Reprod Med. 1987 May;32(5):328–339. [PubMed] [Google Scholar]
  46. Treloar A. E., Behn B. G., Cowan D. W. Analysis of gestational interval. Am J Obstet Gynecol. 1967 Sep 1;99(1):34–45. doi: 10.1016/s0002-9378(16)34488-x. [DOI] [PubMed] [Google Scholar]
  47. Trofatter K. F., Jr Twin pregnancy. Management of delivery. Clin Perinatol. 1988 Mar;15(1):93–106. [PubMed] [Google Scholar]
  48. Williams R. L., Creasy R. K., Cunningham G. C., Hawes W. E., Norris F. D., Tashiro M. Fetal growth and perinatal viability in California. Obstet Gynecol. 1982 May;59(5):624–632. [PubMed] [Google Scholar]
  49. Yarkoni S., Reece E. A., Holford T., O'Connor T. Z., Hobbins J. C. Estimated fetal weight in the evaluation of growth in twin gestations: a prospective longitudinal study. Obstet Gynecol. 1987 Apr;69(4):636–639. [PubMed] [Google Scholar]

Articles from Bulletin of the New York Academy of Medicine are provided here courtesy of New York Academy of Medicine

RESOURCES