title: Premature rupture of membranes and early mortality among triplets in the United States.
abstract: OBJECTIVE
  We investigated the relationship between premature rupture of the membranes (PROM) and early mortality among triplets in the United States.
  
  
  METHODS
  Analysis was conducted on matched and linked triplet sets born to mothers in the United States between 1995 and 1997. The generalized estimating equation framework was used to generate odds ratios after capturing the effects of sibling correlations within triplet clusters.
  
  
  RESULTS
  Triplets exposed to PROM were twice as likely to experience stillbirth (OR=2.17, 95% CI [1.26-3.41]), neonatal death (OR=2.23, 95% CI [1.70-3.0]) and infant death (OR=2.21, 95% CI [1.72-2.85]), as compared to those who did not. The population-attributable risk for early mortality due to PROM was 11-12%.
  
  
  CONCLUSIONS
  Triplets associated with PROM had a significantly higher level of early mortality than those without. Assuming a causal relationship, 11-12% of all early deaths among triplets in the United States are accounted for by PROM.
authors.affiliation: Division of Geographic Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
authors.forename: Sibylle
authors.initials: S
authors.lastname: Kristensen
authors.forename: Hamisu M
authors.initials: HM
authors.lastname: Salihu
authors.forename: Greg R
authors.initials: GR
authors.lastname: Alexander
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002423:Cause of Death; D016001:Confidence Intervals; D005260:Female; D005313:Fetal Death; D005322:Premature Rupture of Fetal Membranes / Q000150:complications* / Q000401:mortality; D006801:Humans; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D008423:Maternal Age; D016017:Odds Ratio; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D011272:Pregnancy, Multiple; D015995:Prevalence; D011336:Probability; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014310:Triplets; D014481:United States / Q000453:epidemiology