Glinianaia S V, Rankin J, Renwick M
Department of Epidemiology & Public Health, The Medical School, University of Newcastle, Newcastle upon Tyne, UK.
Twin Res. 1998 Dec;1(4):189-95. doi: 10.1375/136905298320566159.
The dynamics of perinatal mortality rates (PNMR) and causes of death in twin pregnancies over 13 years in the Northern Region of the National Health Service in England is described. All twin perinatal deaths occurring between 1982-1994 were identified from the Northern Region Perinatal Mortality Survey. The twinning rate increased from 9.9 per 1000 maternities in 1982 to 12.0 in 1994. There was a total of 10,734 twin pregnancies and of these 421 resulted in 530 perinatal deaths. The perinatal mortality rate in twins significantly decreased over time (1982-87, 55.4 per 1000; 1988-94, 44.4 per 1000; P = 0.01). The PNMR was significantly higher for twins from like-sexed than from unlike-sexed pairs (53.5 and 34.4 per 1000 respectively, P < 0.001). Despite no improvement in birthweight distribution in the twin population, birthweight-specific perinatal mortality rates for both like and unlike-sexed twins decreased for each birthweight category in 1988-94 compared with 1982-87. Twins with very low birthweight (< 1500 g) comprised 69%, and preterm twins (< 37 completed weeks of gestation) 74.9% of all twin perinatal deaths. The major immediate cause of early neonatal death was pulmonary immaturity (63%); antepartum anoxia caused 76.9% of antenatal deaths. Unexplained preterm labour and intrauterine death were the leading obstetric factors underlying death in twins. Despite a decrease over the 13 years, the perinatal mortality rate in twins in the Northern Region remains high. Continued monitoring of trends in twinning and mortality rates is needed to inform health care planning.
本文描述了英格兰国民医疗服务体系（NHS）北部地区13年间双胎妊娠围产期死亡率（PNMR）及死亡原因的动态变化。1982 - 1994年间发生的所有双胎围产期死亡病例均来自北部地区围产期死亡率调查。双胎妊娠率从1982年的每1000例产妇9.9例增至1994年的12.0例。共有10734例双胎妊娠，其中421例导致530例围产期死亡。双胎围产期死亡率随时间显著下降（1982 - 1987年，每1000例55.4例；1988 - 1994年，每1000例44.4例；P = 0.01）。同性双胎的PNMR显著高于异性双胎（分别为每1000例53.5例和34.4例，P < 0.001）。尽管双胎群体的出生体重分布没有改善，但与1982 - 1987年相比，1988 - 1994年同性和异性双胎各出生体重组的出生体重特异性围产期死亡率均有所下降。极低出生体重（< 1500 g）的双胎占所有双胎围产期死亡的69%，早产双胎（< 37孕周）占74.9%。早期新生儿死亡的主要直接原因是肺不成熟（63%）；产前缺氧导致76.9%的产前死亡。不明原因的早产和宫内死亡是双胎死亡的主要产科因素。尽管13年间有所下降，但北部地区双胎的围产期死亡率仍然很高。需要持续监测双胎妊娠率和死亡率趋势，以为医疗保健规划提供信息。
