Perinatal Mortality in Multiple Pregnancy Patients

Abstract

A study of perinatal mortality in multiple pregnancy over a period of 12 years, 1972 to 1984, showed prematurity and low birthweight as the major causes of fetal loss. The highest risk was found at 28 to 30 weeks gestation (306/1,000). There was a significantly greater risk to babies delivered by the breech (136/1,000), and likewise in the second twin when compared with the first, ratio 1:14. A significant drop in the perinatal mortality rate, from 98/1,000 to 39/1,000, was observed between 1972-1978 and 1979-1984. Ultrasound has facilitated the earlier diagnosis of twins and provides more accurate serial fetal assessment. Bedrest, more vigilant antenatal care, intrapartum surveillance and improved neonatal care, are required to maintain and further reduce the perinatal mortality rate. When regional analgesia was employed in labour, the number of babies lost was 41/1,000, vs 93/1,000 in patients not receiving regional analgesia. External cephalic version and vertex delivery of the second twin is preferable to internal version and breech extraction. It should also be contemplated, as an alternative to elective cesarean section for a transverse lie or breech presentation of the second fetus.

Comparative trends in cause‐specific fetal and neonatal mortality in twin and singleton births in the North of England, 1982–1994

“…The enhanced efficacy in prenatal management of twin gestation and in neonatal intensive care due to technological advances during the past 20 years has led to a considerable improvement in both twin fetal mortality and survival of extremely preterm infants 37,38 . Early diagnosis of twin pregnancy, antenatal determination of chorionicity, serial ultrasound scanning, evaluation of fetal wellbeing with the biophysical profile score and umbilical arterial Doppler velocimetry might all have contributed to a decrease in twin perinatal mortality 9,32,39–42 . Furthermore, with accurate prenatal diagnosis, intensive fetal surveillance, and appropriately timed delivery, perinatal survival of the most vulnerable category of twins—monoamniotic—has improved 43 .…”

“…The risk of perinatal death is much higher among twins than singletons 1–6 , and this difference for twins has not changed over time. The commonest cause of poor outcome for twin pregnancies is immaturity 7–10 . Preterm births (< 37 weeks of gestation) occur approximately 5‐5.5 times more frequently in twins compared with singletons 3,5,11,12 .…”

Multiple Pregnancy Management: The King Khalid University Hospital Experience

“…Internal podalic version and breech extraction have become less popular, even when the second twin weighs more than 1500 g. 16 This is because of the danger of possible trauma to the fetus during uterine manipulations. Hence, internal podalic version was not undertaken except once in this study and the fetal outcome (Apgar score at five minutes) was not statistically significantly different from those of the controls.…”

Mode of delivery of twins. An 11 year review (1980–1990)

“…Internal version and breech extraction has become less popular, even though with second twins weighing more than 15OOg, route of delivery is not very important (Meehan et al, 1988).…”