Early neonatal mortality in twin pregnancy: Findings from 60 low- and middle-income countries
Early neonatal mortality in twin pregnancy: Findings from 60 low- and middle-income countries
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DOI：
10.7189/jogh.08.010404
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发表时间：
2018-06-01
影响因子：
7.2
通讯作者：
Temmerman, Marleen
中科院分区：
文献类型：
--
作者：
Bellizzi, Saverio;Sobel, Howard;Temmerman, Marleen
在世界各地，多胎妊娠的发生率在中部非洲国家达到高峰，由于这些国家的产科并发症发生率较高，管理技能较差，因此往往增加了妇女和儿童的死亡风险。我们试图评估双胞胎和单胎妊娠相比与早期新生儿死亡率之间的关系。我们还评估了熟练的助产士和分娩方式对双胎妊娠早期新生儿死亡率的作用。方法我们对60个具有全国代表性的人口与健康调查的个人水平数据进行了二次分析，其中包括521 867例单胎和14 312例双胎。我们调查了双胞胎与单胞胎出生后第一周内死亡的发生率，以及出生地点和护理的影响;此外，在全球范围内以及在国家分层后，检查了剖腹产对阴道分娩的作用。一个多层次的logistic回归解释的同质性内的国家，和同质性内双胞胎pairs.Results双胞胎的早期新生儿死亡率显着较高时，单胎新生儿（调整后的比值比（aOR）7.6，95%置信区间（CI）= 7.0-8.3），在这60个国家。在对有出生体重数据的国家进行的亚组分析中，当调整出生体重时，双胞胎的早期新生儿死亡率也高于单胞胎（n = 20;小于20%的缺失值）（aOR = 2.8; 95% CI = 2.2-3.5）。在剖腹产率高（> 15%）的国家，与剖腹产双胞胎相比，在卫生机构经阴道分娩的双胞胎的早期新生儿死亡风险在统计学上显著增加（aOR = 4.8; 95% CI = 2.4-9.4）。与在家中分娩的SBA相比，在家中分娩的无SBA双胞胎的死亡率增加（aOR = 1.3; 95%CI = 1.0-1.8）和在卫生机构阴道分娩（aOR = 1.7;结论对于中、低出生率的双胎妊娠，可考虑住院分娩和增加剖腹产的机会。减少新生儿早期不良结果。
Background Around the world, the incidence of multiple pregnancies reaches its peak in the Central African countries and often represents an increased risk of death for women and children because of higher rates of obstetrical complications and poor management skills in those countries. We sought to assess the association between twins and early neonatal mortality compared with singleton pregnancies. We also assessed the role of skilled birth attendant and mode of delivery on early neonatal mortality in twin pregnancies.Methods We conducted a secondary analysis of individual level data from 60 nationally-representative Demographic and Health Surveys including 521 867 singleton and 14 312 twin births. We investigated the occurrence of deaths within the first week of life in twins compared to singletons and the effect of place and attendance at birth; also, the role of caesarean sections against vaginal births was examined, globally and after countries stratification per caesarean sections rates. A multi-level logistic regression was used accounting for homogeneity within country, and homogeneity within twin pairs.Results Early neonatal mortality among twins was significantly higher when compared to singleton neonates (adjusted odds ratio (aOR) 7.6; 95% confidence interval (CI) = 7.0-8.3) in these 60 countries. Early neonatal mortality was also higher among twins than singletons when adjusting for birth weight in a subgroup analysis of those countries with data on birth weight (n = 20; less than 20% of missing values) (aOR = 2.8; 95% CI = 2.2-3.5). For countries with high rates (> 15%) of caesarean sections (CS), twins delivered vaginally in health facility had a statistically significant (aOR = 4.8; 95% CI = 2.4-9.4) increased risk of early neonatal mortality compared to twins delivered through caesarean sections. Home twin births without SBA was associated with increased mortality compared with delivering at home with SBA (aOR = 1.3; 95% CI = 1.0-1.8) and with vaginal birth in health facility (aOR = 1.7; 95% CI = 1.4-2.0).Conclusions Institutional deliveries and increased access of caesarian sections may be considered for twin pregnancies in low-and middle-income countries to decrease early adverse neonatal outcomes.