title: A population-based cohort study of stillbirth among twins in Lusaka, Zambia.
abstract: OBJECTIVE
  To determine rates of stillbirth and the associated risk factors for stillbirth among twins delivered in Lusaka, Zambia.
  
  
  METHODS
  A retrospective cohort analysis was conducted of singletons and twins delivered at 26 public sector facilities between February 1, 2006, and May 31, 2013. Data were obtained from the Zambian Electronic Perinatal Record System. Risk of stillbirth was estimated using logistic regression.
  
  
  RESULTS
  Overall, 260 657 singletons and 4021 twin pairs were included. There were 5105 stillbirths; 317 twins were stillborn. The crude stillbirth rate for twins was 39.4 per 1000 births (95% confidence interval [CI] 35.2-43.7) whereas the rate for singletons was 18.4 per 1000 births (95% CI 17.9-18.9; P<0.001). Factors associated with stillbirth among twins were increased interval between delivery (>60 minutes), low birth weight (<2500 g), birth order (being the second-born), and difference in birth weights (>30% discordance).
  
  
  CONCLUSIONS
  Twins were at an increased risk of stillbirth. Improved understanding of factors associated with stillbirth in this population could help to improve perinatal outcomes globally.
authors: Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: elizabeth_stringer@med.unc.edu.
authors: Elizabeth M
authors: EM
authors: Stringer
authors: Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
authors: Carla
authors: C
authors: Chibwesha
authors: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors: Marie
authors: M
authors: Stoner
authors: Department of Obstetrics and Gynaecology, University Teaching Hospital, Lusaka, Zambia.
authors: Bellington
authors: B
authors: Vwalika
authors: Clinton Health Access Initiative, Boston, MA, USA.
authors: Jessica
authors: J
authors: Joseph
authors: Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
authors: Benjamin H
authors: BH
authors: Chi
authors: Department of Obstetrics and Gynaecology, University Teaching Hospital, Lusaka, Zambia.
authors: Eugene
authors: E
authors: Kaunda
authors: Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors: William
authors: W
authors: Goodnight
authors: Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors: Jeffrey S A
authors: JS
authors: Stringer
mesh_terms: D001722:Birth Order; D001724:Birth Weight; D036861:Delivery, Obstetric; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D011247:Pregnancy; D059285:Pregnancy, Twin; D012189:Retrospective Studies; D012307:Risk Factors; D050497:Stillbirth / Q000453:epidemiology*; D014427:Twins; D015024:Zambia / Q000453:epidemiology
keywords: Africa; Stillbirth; Twins; Urban; Zambia