The origin and outcome of preterm twin pregnancies

doi:10.1016/0029-7844(94)00455-M

Obstetrics & Gynecology

Volume 85, Issue 4, April 1995, Pages 553-557

https://doi.org/10.1016/0029-7844(94)00455-M Get rights and content

Objective

To define the etiology of preterm twin births and determine the contribution of twin births to preterm birth and related morbidity and mortality.

Methods

The March of Dimes Multicenter Prematurity and Prevention Study included a total of 33,873 women who delivered between 1982–1986, 432 (1.3%) of which delivered twins. Women were classified by reason for preterm birth and ethnicity. Neonates were classified as to stillbirth, neonatal death, and various short-term morbidities. A second data set from one center consisted of infants who weighed 1000 g or less, were born between 1979–1991, and survived to 1 year of age (n = 386, 15% twins); this was used to determine if twins and singletons born at comparable gestational ages have a similar risk for major developmental handicaps.

Results

Of the deliveries in the data set, 54% of twins were preterm compared with 9.6% among singletons. Of those born preterm, twins were born at a significantly earlier gestational age than were singletons. Only 2.6% of all neonates born were twins, but they represented 12.2% of all preterm infants, 15.4% of all neonatal deaths, and 9.5% of all fetal deaths. Spontaneous labor accounted for 54% of twin births, premature rupture of membranes accounted for 22%, and indicated deliveries accounted for 23%. Of the indicated preterm births in twins, 44% were due to maternal hypertension, 33% to fetal distress or fetal growth restriction, 9% to placental abruption, and 7% to fetal death. Comparing infants of similar gestational age, twins weighed less, but had a mortality equivalent to that of singletons after 29 weeks. Between 26–28 weeks' gestation, the risk of mortality for twins versus singletons was 1.6 (95% confidence interval 1.1–2.5). Preterm twins did not have significantly more respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, or other short-term morbidity than did preterm singletons. Twins who weighed 500–1000 g and survived to 1 year had a 25% rate of major developmental handicaps. However, when gestational age was controlled, the rate of major handicaps was not higher in twins than in singletons.

Conclusions

Twins accounted for a disproportional amount of preterm birth and associated morbidity and mortality. Also, when preterm twins were compared with preterm singletons and corrected for their gestational ages, the rates of morbidity were similar. Preterm twins weighing less than 1000 g did not have an increased prevalence of major handicaps at 1 year of age compared with preterm singletons.

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^*: Supported in part by the March of Dimes and the Agency for Health Care Policy and Research, contract no. DHHS 282-92-0055.

View full text

The origin and outcome of preterm twin pregnancies*

Objective

Methods

Results

Conclusions

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Etiologies of preterm birth in an indigent population: Is prevention a logical expectation?

Obstet Gynecol

Effects of prenatal care on twin gestations

J Reprod Med

Reduction in very low birth weight deliveries and perinatal mortality in a specialized multidisciplinary twin clinic

Obstet Gynecol

Multicenter randomized, controlled trial of a preterm birth prevention program

Am J Obstet Gynecol

Neonatal morbidity according to gestational age and birth weight from five tertiary care centers in the United States, 1983 through 1986

Am J Obstet Gynecol