title: Early mortality in twin pregnancies complicated by premature rupture of membranes in the United States.
abstract: There is little information on mortality among multiple gestations complicated by premature rupture of membranes (PROM). In this study, we estimated the occurrence of the components of early mortality (stillbirth, neonatal and infant mortality) among twin pregnancies using the generalised estimating equation framework to account for intra-cluster correlations. Using the population-attributable risk, we also computed the level of excess mortality that could be averted by preventing PROM. Our findings reveal that the likelihood of stillbirth (odds ratio (OR) = 1.88; 95% confidence interval (CI)=1.66-2.13), neonatal mortality (OR=3.45; 95% CI=3.18-3.74) and infant mortality (OR=3.26; 95% CI=3.03-3.50) was significantly higher among twin pregnancies exposed to PROM. Approximately 6% of all stillbirths, 15% of neonatal mortality and 14% of infant mortality among twins in the United States are attributable to PROM. We conclude that PROM is associated with an increased level of early mortality among twins.
authors.affiliation: Division of Geographic Medicine, School of Medicine, University of Alabama at Birmingham, 35294, USA.
authors.forename: Sibylle
authors.initials: S
authors.lastname: Kristensen
authors.forename: H M
authors.initials: HM
authors.lastname: Salihu
authors.forename: Helen
authors.initials: H
authors.lastname: Ding
authors.forename: G R
authors.initials: GR
authors.lastname: Alexander
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000401:mortality*; D006801:Humans; D015994:Incidence; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000401:mortality*; D007234:Infant, Premature; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple; D012307:Risk Factors; D014427:Twins; D014481:United States / Q000453:epidemiology