Reduction in very low birth weight deliveries and perinatal mortality in a specialized, multidisciplinary twin clinic.
OBJECTIVE
To determine whether a specialized, multidisciplinary twin clinic could reduce rates of very low birth weight (VLBW) and perinatal mortality. Multifetal gestations account for only 1% of all pregnancies, yet are responsible for nearly 10% of all perinatal mortality. Very low birth weight (less than 1500 g) infants are the major contributors to this increased perinatal mortality rate.


METHODS
Eighty-nine twin pairs followed in the Twin Clinic since 1988 were compared with 51 contemporary twin pairs who did not attend the Twin Clinic. Patients not attending the Twin Clinic were attended in the high-risk clinic by the obstetric residents and faculty. All maternal transports were excluded. Aspects of prenatal care emphasized in the Twin Clinic that differed from the high-risk clinic included consistent evaluation of maternal symptoms and cervical status by a single certified nurse-midwife, intensive preterm birth prevention education, individualized modification of maternal activity, increased attention to nutrition, and tracking of clinic non-attenders.


RESULTS
There were no differences between the groups in demographic characteristics, adequacy of prenatal care, or antepartum complications. However, Twin Clinic attenders had lower rates of VLBW infants, neonatal intensive care unit admission, and perinatal mortality.


CONCLUSIONS
These improvements in perinatal outcome for twin gestations are attributed to intensive preterm birth prevention education, individualization of prenatal care, and frequent maternal assessment by a consistent care provider. This approach reduced the rate of very early preterm delivery and its neonatal sequelae.
Ellings
J M
JM
Medical University of South Carolina, Charleston.
Newman
R B
RB
Hulsey
T C
TC
Bivins
H A
HA
Keenan
A
A
D000328:Adult; D005260:Female; D006785:Hospitals, University / Q000458:organization & administration; D006801:Humans; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D009721:Nurse Midwives; D007752:Obstetric Labor, Premature / Q000453:epidemiology / Q000517:prevention & control*; D009775:Obstetrics and Gynecology Department, Hospital / Q000458:organization & administration*; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000517:prevention & control*; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000458:organization & administration*; D012307:Risk Factors; D013022:South Carolina; D014427:Twins