Lynch Anne, McDuffie Robert, Lyons Ella, Chase Mary, Orleans Miriam
Perm J. 2007 Winter;11(1):7-12. doi: 10.7812/TPP/05-101.
We evaluated prenatal factors related to perinatal loss in twins, using medical records and death certificates, to determine the main perinatal event that contributed to babies' deaths.
This was a retrospective cohort study of 550 monochorionic diamniotic or diamniotic dichorionic twins who were delivered at Kaiser Permanente Colorado between 1994 and 2001.
The main outcome of the study was perinatal loss (stillbirth or neonatal death).
Select maternal risk factors (maternal age, race, marital status, assisted conception, past history of preterm birth, cigarette smoking, and placentation) were included in the univariable and multivariable logistic regression analysis. Data on these risk factors came from review of records from our multiple-birth perinatal database. A comprehensive review of clinical events recorded in the medical records and on the death certificate was conducted to assess the main event that contributed to the loss.
In the cohort of 1100 babies, there were 12 stillbirths and 34 neonatal deaths, with an overall frequency of perinatal loss of 4.2%. We found a strong association between a monochorionic diamniotic placentation and perinatal loss (adjusted odds ratio, 3.9; 95% confidence interval, 2, 7.7). At delivery, placental pathology and spontaneous preterm birth accounted for 36% and 41%, respectively, of the clinical events contributing to the demises. Compared with the medical record, review of death certificate information did not contribute significantly to the understanding of the sequence of perinatal events leading to the demise.
We conclude that loss in twins is most strongly associated with monochorionic diamniotic placentation. Although this condition is not preventable, early identification (by ultrasound) and referral to subspecialists may decrease the chances of perinatal loss. Prevention of spontaneous preterm birth in all women remains an important initiative in obstetric care to reduce perinatal mortality and neonatal morbidity. We believe that improvements in the reporting on death certificates will allow future research on large data sets and may provide further insight into perinatal loss in twins. We emphasize the importance of a comprehensive clinical review of each case of perinatal loss to fully understand the sequence of clinical events leading to this adverse pregnancy outcome.
我们利用病历和死亡证明评估与双胎围产期死亡相关的产前因素，以确定导致婴儿死亡的主要围产期事件。
这是一项对1994年至2001年间在科罗拉多州凯撒医疗中心分娩的550例单绒毛膜双羊膜囊或双绒毛膜双羊膜囊双胎进行的回顾性队列研究。
该研究的主要结局是围产期死亡（死产或新生儿死亡）。
选择的母亲风险因素（母亲年龄、种族、婚姻状况、辅助受孕、既往早产史、吸烟和胎盘情况）纳入单变量和多变量逻辑回归分析。这些风险因素的数据来自对我们多胎围产期数据库记录的审查。对病历和死亡证明中记录的临床事件进行全面审查，以评估导致死亡的主要事件。
在1100例婴儿队列中，有12例死产和34例新生儿死亡，围产期死亡的总体发生率为4.2%。我们发现单绒毛膜双羊膜囊胎盘与围产期死亡之间存在密切关联（调整后的优势比为3.9；95%置信区间为2至7.7）。分娩时，胎盘病理和自发性早产分别占导致死亡的临床事件的36%和41%。与病历相比，审查死亡证明信息对理解导致死亡的围产期事件顺序没有显著帮助。
我们得出结论，双胎死亡与单绒毛膜双羊膜囊胎盘最密切相关。虽然这种情况无法预防，但早期识别（通过超声）并转诊至专科医生可能会降低围产期死亡的几率。预防所有孕妇的自发性早产仍然是产科护理中降低围产期死亡率和新生儿发病率的一项重要举措。我们认为，死亡证明报告的改进将有助于未来对大型数据集的研究，并可能为双胎围产期死亡提供进一步的见解。我们强调对每例围产期死亡病例进行全面临床审查的重要性，以充分了解导致这一不良妊娠结局的临床事件顺序。
