title: Intrauterine fetal death of one twin of diamnionic twins is associated with adverse perinatal outcome of the co-twin.
abstract: OBJECTIVE
  To determine whether intrauterine fetal death (IUFD) of one twin of diamnionic twins after 22 weeks of gestation is associated with adverse perinatal outcome to the co-twin.
  
  
  METHODS
  A retrospective case-control study (n = 4070), including all twin births delivered between the years 1988 and 2010, was conducted. Perinatal outcome of the co-twin in diamnionic pregnancies complicated by IUFD were compared with the first twin from a pair of live-born diamnionic twins. A multiple logistic regression model was constructed to determine the association between IUFD of one twin and postpartum death (PPD) of the co-twin while controlling for confounders such as gestational age.
  
  
  RESULTS
  Pregnancies complicated with IUFD of a co-twin (n = 116) had higher rates of adverse perinatal outcomes such as PPD (9.5% vs. 2.3%, p < 0.001), low Apgar scores (<7) at 1 and 5 min (30.2% vs. 10.6%, p < 0.001 and 6.9% vs. 1.8%, p < 0.001, respectively), lower birth weight (1953 ± 746 g vs. 2299 ± 559 g), and higher rates of preterm birth before 34 weeks of gestation (38.8% vs. 16.4%, p < 0.001). Using a multivariate analysis with PPD as the outcome variable, mortality was attributed to gestational age (adjusted OR = 0.58; 95% CI 0.5-0.6, p < 0.001) and not to the IUFD per se (adjusted OR = 1.3, 95% CI 0.5-3.3, p = 0.552).
  
  
  CONCLUSIONS
  Intrauterine fetal death of one twin (of diamnionic twins) is associated with adverse perinatal outcome of the co-twin mainly due to prematurity.
authors: The Joyce and Irving Goldman Medical school, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, Be'er-Sheva, Israel.
authors: Uriel
authors: U
authors: Giwnewer
authors: Arnon
authors: A
authors: Wiznitzer
authors: Jordana Mashiach
authors: JM
authors: Friedler
authors: Ruslan
authors: R
authors: Sergienko
authors: Eyal
authors: E
authors: Sheiner
mesh_terms: D000328:Adult; D000650:Amnion; D016022:Case-Control Studies; D004200:Diseases in Twins / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005313:Fetal Death / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology* / Q000209:etiology; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D059285:Pregnancy, Twin / Q000706:statistics & numerical data; D047928:Premature Birth / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D050497:Stillbirth / Q000453:epidemiology; D014429:Twins, Dizygotic / Q000706:statistics & numerical data*; D055815:Young Adult