Moreault L, Marcoux S, Fabia J, Tennina S
Department of Social and Preventive Medicine, Laval University, Quebec City, Canada.
Acta Genet Med Gemellol (Roma). 1991;40(2):181-92. doi: 10.1017/s0001566000002622.
This study describes the evolution in fetal and neonatal mortality rates among twin pairs born in 22 hospitals located in the eastern regions of the province of Quebec in 1976-1978 (n = 776 pairs) and 1982-1985 (n = 712 pairs). It also assesses the contribution of maternal factors, obstetrical care and characteristics of twins in the variation of the risk of death over time. The fetal mortality rate did not improve from 1976-1978 (22.6 per 1000) to 1982-1985 (28.1 per 1000). However, the neonatal mortality rate declined from 44.7 to 34.7 per 1000 liveborn first twins and from 56.8 to 36.1 per 1000 liveborn second twins. For first twins as for second twins, birthweight-specific neonatal mortality rates decreased within birthweight categories under 2500 g. In the second period, 96.9% of twin pregnancies were detected before confinement compared to 59.6% in the earlier period. The proportion of twins delivered by obstetricians, the percentage of twin births occurring in ultraspecialized perinatal units and the frequency of caesarean sections increased markedly. The proportion of preterm births increased over time (34.5% vs 43.1%) whereas the percentage of low birthweight twins decreased but not significantly (54.3% 51.6%). In this study, changes in maternal age, parity, educational level, sex of pairs, qualification of the physician, and level of care available at the hospital of birth, did not account for the decrease in neonatal mortality rates among twins. The increase in the frequency of caesarean sections seemed to explain only a small proportion of the decrease in the neonatal mortality rate among second twins. In the second as well as in the first period, the neonatal mortality rate for twins was six times higher than that for singletons.
本研究描述了1976 - 1978年（n = 776对）和1982 - 1985年（n = 712对）在魁北克省东部地区22家医院出生的双胞胎对中胎儿和新生儿死亡率的演变情况。它还评估了母亲因素、产科护理和双胞胎特征对死亡风险随时间变化的影响。胎儿死亡率从1976 - 1978年的每1000例22.6例没有改善到1982 - 1985年的每1000例28.1例。然而，新生儿死亡率从每1000例活产第一对双胞胎中的44.7例下降到34.7例，从每1000例活产第二对双胞胎中的56.8例下降到36.1例。对于第一对双胞胎和第二对双胞胎，出生体重低于2500克的类别中，特定出生体重的新生儿死亡率均有所下降。在第二个时期，96.9%的双胞胎妊娠在分娩前被检测到，而早期这一比例为59.6%。由产科医生接生的双胞胎比例、在超专科围产期单位出生的双胞胎出生百分比以及剖宫产频率显著增加。早产比例随时间增加（34.5%对43.1%），而低出生体重双胞胎的百分比有所下降但不显著（54.3%对51.6%）。在本研究中，母亲年龄、产次、教育水平、双胞胎性别、医生资质以及出生医院的护理水平的变化，并不能解释双胞胎新生儿死亡率的下降。剖宫产频率的增加似乎仅解释了第二对双胞胎新生儿死亡率下降的一小部分。在第二个时期以及第一个时期，双胞胎的新生儿死亡率均比单胎高出五倍。 （注：原文中“six times higher than”直译为“比……高六倍”，实际意思是“是……的六倍”，译文按正确理解翻译）
