title: Perinatal mortality and mode of delivery in monochorionic diamniotic twin pregnancies ≥ 32 weeks of gestation: a multicentre retrospective cohort study.
abstract: OBJECTIVE
  To study perinatal mortality rates in a cohort of 465 monochorionic (MC) twins without twin-twin transfusion syndrome (TTS) born at 32 weeks of gestation or later since reported interauterine fetal death (IUFD) rates >32 weeks of gestations in the literature vary, leading to varying recommendations on the optimal timing of delivery, and to investigate the relation between perinatal mortality and mode of delivery.
  
  
  METHODS
  Multicentre retrospective cohort study.
  
  
  METHODS
  Ten perinatal referral centres in the Netherlands.
  
  
  METHODS
  All MC twin pregnancies without TTTS delivered at ≥ 32 weeks of gestation between January 2000 and December 2005.
  
  
  METHODS
  The medical records of all MC twin pregnancies without TTTS delivered at the ten perinatal referral centres in the Netherlands between January 2000 and December 2005 were reviewed.
  
  
  METHODS
  Perinatal mortality in relation to gestational age and mode of delivery at ≥ 32 weeks of gestation.
  
  
  RESULTS
  After 32 weeks of gestation, five out of 930 fetuses died in utero and there were six neonatal deaths (6 per 1000 infants). In women who delivered ≥ 37 weeks, perinatal mortality was 7 per 1000 infants. Trial of labour was attempted in 376 women and was successful in 77%. There were three deaths in deliveries with a trial of labour (8 per 1000 deliveries), of which two were related to mode of delivery. Infants born by caesarean section without labour had an increased risk of neonatal morbidity and respiratory distress syndrome.
  
  
  CONCLUSIONS
  In MC twin pregnancies the incidence of intrauterine fetal death is low ≥ 32 weeks of gestation. Therefore, planned preterm delivery before 36 weeks does not seem to be justified. The risk of intrapartum death is also low, at least in tertiary centres.
authors.affiliation: Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands. k.e.a.hack@umcutrecht.nl
authors.forename: K E A
authors.initials: KE
authors.lastname: Hack
authors.forename: J B
authors.initials: JB
authors.lastname: Derks
authors.forename: S G
authors.initials: SG
authors.lastname: Elias
authors.forename: F A
authors.initials: FA
authors.lastname: van Mameren
authors.forename: C
authors.initials: C
authors.lastname: Koopman-Esseboom
authors.forename: B W J
authors.initials: BW
authors.lastname: Mol
authors.forename: E
authors.initials: E
authors.lastname: Lopriore
authors.forename: A H P
authors.initials: AH
authors.lastname: Schaap
authors.forename: B
authors.initials: B
authors.lastname: Arabin
authors.forename: J J
authors.initials: JJ
authors.lastname: Duvekot
authors.forename: A T J I
authors.initials: AT
authors.lastname: Go
authors.forename: E
authors.initials: E
authors.lastname: Wieselmann
authors.forename: A J
authors.initials: AJ
authors.lastname: Eggink
authors.forename: C
authors.initials: C
authors.lastname: Willekes
authors.forename: F P H A
authors.initials: FP
authors.lastname: Vandenbussche
authors.forename: G H A
authors.initials: GH
authors.lastname: Visser
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects; D015331:Cohort Studies; D005260:Female; D005313:Fetal Death / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011247:Pregnancy; D011272:Pregnancy, Multiple; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology; D012189:Retrospective Studies; D014219:Trial of Labor; D014430:Twins, Monozygotic; D055815:Young Adult