Skeie Annelise, Frøen J Frederik, Vege Ashild, Stray-Pedersen Babill
Laerdal Hospital, and Department of Obstetrics and Gynecology, Rikshospitalet University Clinic, University of Oslo, Norway.
Acta Obstet Gynecol Scand. 2003 Nov;82(11):1010-6. doi: 10.1034/j.1600-0412.2003.00288.x.
The epidemiology of twin pregnancies complicated by stillbirth of one or both fetuses is a scarcely examined area. The risk of perinatal death in twin pregnancies is increased 2-5 times compared to singletons, and the identification of preventable risk factors becomes increasingly important as the number of multiple pregnancies is rising. We report the causes of death in twin pregnancies and their respective risk factors.
Twin pregnancies (n = 54) complicated by antepartum or intrapartum stillbirth of one or both twins (n = 68) and twin pregnancies with normal outcome (n = 103) in the counties of Oslo and Akershus, Norway, from 1986 to 1995 were included. The cases were classified and compared to the controls in multiple logistic regression analyses with regard to risk factors.
The risk of stillbirth increased with monochorionicity, non-Western origin and assisted reproduction techniques (ART). The cases could be divided into eight different groups according to the primary diagnosis. The groups did not fit any of the existing cause-of-death classifications used on singleton stillbirths.
The identification of monochorionic gestation should be made early in pregnancy to designate the level of risk. Assisted reproduction techniques leading to a high incidence of twins should be avoided. Health care professionals in the immigrant population should address the detrimental effects of consanguinity on reproductive outcome. We emphasize the need of a new cause-of-death classification for twin stillbirths.
双胎妊娠合并单胎或双胎死产的流行病学是一个鲜少被研究的领域。与单胎妊娠相比，双胎妊娠围产期死亡风险增加2至5倍，随着多胎妊娠数量的增加，识别可预防的风险因素变得越来越重要。我们报告双胎妊娠的死亡原因及其各自的风险因素。
纳入1986年至1995年挪威奥斯陆和阿克什胡斯郡的双胎妊娠（n = 54），其中单胎或双胎在产前或产时死产（n = 68），以及结局正常的双胎妊娠（n = 103）。在多因素逻辑回归分析中，对病例进行分类并与对照组比较风险因素。
死产风险随着单绒毛膜性、非西方血统和辅助生殖技术（ART）而增加。根据主要诊断，病例可分为八个不同组。这些组不符合单胎死产现有的任何死因分类。
应在妊娠早期识别单绒毛膜妊娠以确定风险水平。应避免导致双胎高发生率的辅助生殖技术。移民人群中的医疗保健专业人员应关注近亲结婚对生殖结局的有害影响。我们强调需要为双胎死产制定新的死因分类。
