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Published in: BMC Pregnancy and Childbirth 1/2020

01-12-2020 | Research article

Perinatal outcomes in Finnish twins: a retrospective study

Authors: Annu-Riikka Susanna Rissanen, Riina Maria Jernman, Mika Gissler, Irmeli Katriina Nupponen, Mika Erkki Nuutila

Published in: BMC Pregnancy and Childbirth | Issue 1/2020

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Abstract

Background

To establish the changes in perinatal morbidity and mortality in twin pregnancies in Finland, a retrospective register research was conducted. Our extensive data from a 28-year study period provide important information on the outcome of twin pregnancies in Finland that has previously not been reported to this extent.

Methods

All 23,498 twin pregnancies with 46,996 children born in Finland during 1987–2014 were included in the study. Data were gathered from the Medical Birth Register and the Hospital Discharge Register (Finnish Institute for Health and Welfare, Finland) regarding perinatal mortality (PNM) and morbidity. For statistical analysis, binomial regression analysis and crosstabs were performed. The results are expressed in means, percentages and ranges with comparison to singletons when appropriate. Odds ratios from binomial regression analysis are reported. A p-value <0.05 was considered statistically significant.

Results

There were 46,363 liveborn and 633 stillborn twins in Finland during 1987–2014. Perinatal mortality decreased markedly, from 45.1 to 6.5 per 1000 for twin A and from 54.1 to 11.9 per 1000 for twin B during the study period. Yet, the PNM difference between twin A and B remained. Early neonatal mortality did not differ between twins, but has decreased in both. Asphyxia, respiratory distress syndrome, need for antibiotics and Neonatal Intensive Care Unit (NICU) stay were markedly more common in twin B.

Conclusions

In Finland, PNM and early neonatal mortality in twins decreased significantly during 1987–2014 and are nowadays very low. However, twin B still faces more complications. The outline provided may be used to further improve the monitoring and thus perinatal outcome of twins, especially twin B.
Literature
1.
3.
go back to reference Fox NS, Rebarber A, Dunham SM, Saltzman DH. Outcomes of multiple gestations with advanced maternal age. J Matern Fetal Neonatal Med. 2009;22:593–6.CrossRef Fox NS, Rebarber A, Dunham SM, Saltzman DH. Outcomes of multiple gestations with advanced maternal age. J Matern Fetal Neonatal Med. 2009;22:593–6.CrossRef
4.
go back to reference Sultana R, Chen XK, Lee C, Hader J. Outcomes in multiple gestation pregnancies among Canadian women age 35 years and older. Healthcare Quarterly. 2011;14:22–4.CrossRef Sultana R, Chen XK, Lee C, Hader J. Outcomes in multiple gestation pregnancies among Canadian women age 35 years and older. Healthcare Quarterly. 2011;14:22–4.CrossRef
5.
go back to reference Kabiru W, Raynor BD. Obstetric outcomes associated with increase in BMI category during pregnancy. Am J Obstet Gynecol. 2004;191:928–32.CrossRef Kabiru W, Raynor BD. Obstetric outcomes associated with increase in BMI category during pregnancy. Am J Obstet Gynecol. 2004;191:928–32.CrossRef
6.
go back to reference Tiitinen A, Hydén-Granskog C, Gissler M. What is the most relevant standard of success in assisted reproduction? The value of cryopreservation on cumulative pregnancy rates per single oocyte retrieval should not be forgotten. Hum Reprod. 2004;19:2439–41.CrossRef Tiitinen A, Hydén-Granskog C, Gissler M. What is the most relevant standard of success in assisted reproduction? The value of cryopreservation on cumulative pregnancy rates per single oocyte retrieval should not be forgotten. Hum Reprod. 2004;19:2439–41.CrossRef
7.
go back to reference Tiitinen A, Gissler M. Effect of in vitro fertilization practices on multiple pregnancy rates in Finland. Fertil Steril. 2004;82:1689–90.CrossRef Tiitinen A, Gissler M. Effect of in vitro fertilization practices on multiple pregnancy rates in Finland. Fertil Steril. 2004;82:1689–90.CrossRef
8.
go back to reference Vasak B, Verhagen JJ, Koenen SV, Koster MPH, de Reu PAOM, Franx A, et al. Lower perinatal mortality in preterm born twins than in singletons: a nationwide study from the Netherlands. Am J Obstet Gynecol. 2017;216:161.e1–9.CrossRef Vasak B, Verhagen JJ, Koenen SV, Koster MPH, de Reu PAOM, Franx A, et al. Lower perinatal mortality in preterm born twins than in singletons: a nationwide study from the Netherlands. Am J Obstet Gynecol. 2017;216:161.e1–9.CrossRef
9.
go back to reference Rogers EE, Hintz SR. Early neurodevelopmental outcomes of extremely preterm infants. Semin Perinat. 2016;40:497–509.CrossRef Rogers EE, Hintz SR. Early neurodevelopmental outcomes of extremely preterm infants. Semin Perinat. 2016;40:497–509.CrossRef
10.
go back to reference Hack KEA, Derks JB, Elias SG, van Mameren FA, Koopman-Esseboom C, Mol BWJ, et al. Increased perinatal mortality and morbidity in monochorionic versus dichorionic twin pregnancies: clinical implications of a large Dutch cohort study. BJOG. 2008;115:58–67.CrossRef Hack KEA, Derks JB, Elias SG, van Mameren FA, Koopman-Esseboom C, Mol BWJ, et al. Increased perinatal mortality and morbidity in monochorionic versus dichorionic twin pregnancies: clinical implications of a large Dutch cohort study. BJOG. 2008;115:58–67.CrossRef
11.
go back to reference Armson BA, O’Connell C, Persad V, Joseph KS, Young DC, Baskett TF. Determinants of perinatal mortality and serious neonatal morbidity in the second twin. Obstet Gynecol. 2006;108:556–64.CrossRef Armson BA, O’Connell C, Persad V, Joseph KS, Young DC, Baskett TF. Determinants of perinatal mortality and serious neonatal morbidity in the second twin. Obstet Gynecol. 2006;108:556–64.CrossRef
12.
13.
go back to reference Alexander JM, Leveno KJ, Rouse D, Landon MB, Gilbert SA, Spong CY, et al. Cesarean delivery for the second twin. Obstet Gynecol. 2008;112:748–52.CrossRef Alexander JM, Leveno KJ, Rouse D, Landon MB, Gilbert SA, Spong CY, et al. Cesarean delivery for the second twin. Obstet Gynecol. 2008;112:748–52.CrossRef
14.
go back to reference Santana DS, Silveira C, Costa ML, Souza RT, Surita FG, Souza JP et al Perinatal outcome in twin pregnancies complicated by maternal morbidity: evidence from the WHO multicountry survey on maternal and perinatal health. BMC Pregnancy Childbirth 2018; 18: 449. https://doi.org/https://doi.org/10.1186/s12884-018-2082-9. Santana DS, Silveira C, Costa ML, Souza RT, Surita FG, Souza JP et al Perinatal outcome in twin pregnancies complicated by maternal morbidity: evidence from the WHO multicountry survey on maternal and perinatal health. BMC Pregnancy Childbirth 2018; 18: 449. https://​doi.​org/​https://​doi.​org/​10.​1186/​s12884-018-2082-9.
15.
go back to reference Breathnach FM, McAuliffe FM, Geary M, Daly S, Higgins JR, Dornan J, et al. Optimum timing of planned delivery of uncomplicated monochorionic and dichorionic twin pregnancies. Obstet Gynecol. 2012;119:50–9.CrossRef Breathnach FM, McAuliffe FM, Geary M, Daly S, Higgins JR, Dornan J, et al. Optimum timing of planned delivery of uncomplicated monochorionic and dichorionic twin pregnancies. Obstet Gynecol. 2012;119:50–9.CrossRef
16.
go back to reference National Collaborating Centre for Women’s and Children’s Health (UK). In: Multiple pregnancy: the management of twin and triplet pregnancies in the antenatal period. London: RCOG Press; 2011. National Collaborating Centre for Women’s and Children’s Health (UK). In: Multiple pregnancy: the management of twin and triplet pregnancies in the antenatal period. London: RCOG Press; 2011.
18.
go back to reference Hehir MP, Mctiernan A, Martin A, Carroll S, Gleeson R, Malone FD. Improved perinatal mortality in twins – changing practice and technologies. Am J Perinatol. 2016;33:84–9.PubMed Hehir MP, Mctiernan A, Martin A, Carroll S, Gleeson R, Malone FD. Improved perinatal mortality in twins – changing practice and technologies. Am J Perinatol. 2016;33:84–9.PubMed
19.
go back to reference Blondel B, Macfarlane A, Gissler M, Breart G, Zeitlin J, the PERISTAT study group. Preterm birth and multiple pregnancy in European countries participating in the PERISTAT project. BJOG. 2006;113:528–35.CrossRef Blondel B, Macfarlane A, Gissler M, Breart G, Zeitlin J, the PERISTAT study group. Preterm birth and multiple pregnancy in European countries participating in the PERISTAT project. BJOG. 2006;113:528–35.CrossRef
20.
go back to reference Goldenberg R, Culhane J, Iams J, Romero R. Epidemiology and causes of preterm birth. Lancet. 2008;371:75–84.CrossRef Goldenberg R, Culhane J, Iams J, Romero R. Epidemiology and causes of preterm birth. Lancet. 2008;371:75–84.CrossRef
22.
go back to reference Rovira N, Alarcon A, Iriondo M, Ibanez M, Poo P, Cusi V, et al. Impact of histological chorioamnionitis, funisitis and clinical chorioamnionitis on neurodevelopmental outcome of preterm infants. Early Hum Dev. 2011;87:253–7.CrossRef Rovira N, Alarcon A, Iriondo M, Ibanez M, Poo P, Cusi V, et al. Impact of histological chorioamnionitis, funisitis and clinical chorioamnionitis on neurodevelopmental outcome of preterm infants. Early Hum Dev. 2011;87:253–7.CrossRef
23.
go back to reference Di Renzo GC, Rosati A, Sarti RD, Cruciani L, Cutuli AM. Does fetal sex affect pregnancy outcome? Gender Medicine. 2007;4:19–30.CrossRef Di Renzo GC, Rosati A, Sarti RD, Cruciani L, Cutuli AM. Does fetal sex affect pregnancy outcome? Gender Medicine. 2007;4:19–30.CrossRef
24.
go back to reference Wenckus DJ, Gao W, Kominiarek MA, Wilkins I. The effects of labor and delivery on maternal and neonatal outcomes in term twins: a retrospective cohort study. BJOG. 2014;121:1137–44.CrossRef Wenckus DJ, Gao W, Kominiarek MA, Wilkins I. The effects of labor and delivery on maternal and neonatal outcomes in term twins: a retrospective cohort study. BJOG. 2014;121:1137–44.CrossRef
25.
go back to reference Ylilehto E, Palomäki O, Huhtala H, Uotila J. Term twin birth- impact of mode of delivery on outcome. Acta Obstet Gynecol Scand. 2017;96:589–96.CrossRef Ylilehto E, Palomäki O, Huhtala H, Uotila J. Term twin birth- impact of mode of delivery on outcome. Acta Obstet Gynecol Scand. 2017;96:589–96.CrossRef
27.
go back to reference Emery SP, Bahtiyar MO, Dashe JS, Wikins-Haug LE, Johnson A, Paek BW, et al. The north American fetal therapy network consensus statement. Prenatal management of uncomplicated monochorionic gestations. Obstet Gynecol. 2015;125:1236–43.CrossRef Emery SP, Bahtiyar MO, Dashe JS, Wikins-Haug LE, Johnson A, Paek BW, et al. The north American fetal therapy network consensus statement. Prenatal management of uncomplicated monochorionic gestations. Obstet Gynecol. 2015;125:1236–43.CrossRef
Metadata
Title
Perinatal outcomes in Finnish twins: a retrospective study
Authors
Annu-Riikka Susanna Rissanen
Riina Maria Jernman
Mika Gissler
Irmeli Katriina Nupponen
Mika Erkki Nuutila
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2020
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-019-2670-3

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