Blickstein Isaac, Keith Louis G
Department of Obstetrics and Gynecology, Kaplan Medical Center, and the Hadassah-Hebrew University School of Medicine, Jerusalem, Israel.
Am J Obstet Gynecol. 2004 Jan;190(1):170-4. doi: 10.1016/j.ajog.2003.07.025.
The purpose of this study was to evaluate neonatal mortality rates among discordant twins, classified according to the birth weight of the smaller twin.
We compared neonatal mortality rates among three groups of discordant twins (>25%), distinguished by the birth weight of the smaller twin being <10th, 10th to 50th, or >50th percentile.
Among the 10,683 pairs of twins who were studied, the respective proportions of the three groups were 62.4%, 32.9%, and 4.7%. The neonatal mortality rate was significantly higher among pairs in which the smaller twin weighed <10th birth weight percentile (29. vs 11.1 and 11 per 1000; odds ratio, 2.7; 95% CI, 1.3, 5.7). This difference results from the higher mortality rates among the smaller but not among the larger twins.
Severely discordant twin pairs in whom the smaller twin is also small for gestational age are at an increased risk of neonatal death. Identification of this group is an imperative step in the management of birth weight discordance in twin gestations.
本研究旨在评估根据较小胎儿出生体重分类的不一致性双胎新生儿死亡率。
我们比较了三组不一致性双胎（>25%）的新生儿死亡率，这三组根据较小胎儿出生体重处于第10百分位数以下、第10至50百分位数或第50百分位数以上来区分。
在研究的10683对双胎中，三组的各自比例分别为62.4%、32.9%和4.7%。较小胎儿出生体重处于第10百分位数以下的双胎对的新生儿死亡率显著更高（每1000例中分别为29例、11.1例和11例；优势比为2.7；95%可信区间为[1.3, 5.7]）。这种差异是由于较小胎儿死亡率较高，而不是较大胎儿死亡率较高所致。
较小胎儿同时也是小于胎龄儿的严重不一致性双胎对，其新生儿死亡风险增加。识别这一组是双胎妊娠出生体重不一致管理中的关键步骤。
