Most deaths were spontaneous (219/265 83%) selective reduction and death within a week of medical intervention solely affected monochorionic pregnancies (9% of monochorionic deaths (11/122).ĭistribution of causes of perinatal death in twin pregnancies between 20 in the West Midlands irrespective of chorionicity who had undergone a postmortem. Mean gestation at death was 19–20 weeks (range 8–37 weeks). Most deaths, irrespective of chorionicity, were double-twin deaths (246/265 93%) a greater proportion of single twin deaths occurred in dichorionic than in monochorionic pregnancies (8 versus 5%). Most demises were in utero (miscarriages and stillbirths) 7% were NND (18/265), of which 61% (11/18) were dichorionic pregnancies. Chorionicity was undesignated at postmortem in 18% (47/265) as the placenta was either not submitted or unsuitable (too fragmented or incorrectly fixed) for examination. Forty-six per cent of deaths occurred in monochorionic twins (122/265 postmortems). Table 1 summarises maternal demographic and descriptive data. Results General findingsīetween 1 January 2005 and 31 December 2016, 265 fetal and neonatal postmortems from 144 twin pregnancies were performed, referred from 14 hospitals throughout the West Midlands.

15įlowchart demonstrating method of case identification following development of CoDiT classification and assignment of cause of death. 2- 4 Twin pregnancies account for almost 6% of all stillbirths, 18% of neonatal deaths (NND) and 20% of preterm births (many of which occur 0.9, almost perfect. 1 Compared with singletons, monochorionic twins have a 13-fold increased risk of stillbirth and dichorionic twins a five-fold increased risk. Multiple pregnancies occur in 1.6% of pregnancies in England and Wales the commonest are twin pregnancies (98%). New classification system for #twin cause of death ‘CoDiT’ shows high rater agreement. We highlight differences in aetiology of death between monochorionic and dichorionic twins. This novel classification system records causes of death in twin pregnancies from postmortem reports with high inter-user agreement. The commonest cause of death irrespective of chorionicity was the placenta twin-to-twin transfusion syndrome (TTTS) was the commonest placental cause in monochorionic twins and acute chorioamnionitis in dichorionic twins. ResultsĬohen’s Kappa demonstrated ‘strong’ (>0.8) inter-rater, intra-rater and inter-disciplinary agreement (95% CI 0.70–0.91). Inter-rater, intra-rater, inter-disciplinary agreement and cause of death.

Cause of death was validated by another obstetrician blinded to the original classification. The system was tested by assigning cause of death in 265 fetal and neonatal deaths from 144 twin pregnancies. MethodsĪ multidisciplinary panel designed CoDiT by adapting the most appropriate elements of singleton classification systems. Twin pregnancies in the West Midlands affected by fetal or neonatal demise of one or both twins between 1 January 2005 and 31 December 2016 in which postmortem examination was undertaken. Tertiary maternity unit in England with a perinatal pathology service. We introduce and test a classification system designed to assign a cause of death in twin pregnancies (CoDiT). Current classification systems for perinatal death lack twin-specific categories, potentially leading to loss of important information regarding cause of death. Twin pregnancies have a significantly higher perinatal mortality than singleton pregnancies.

Mother lost twins at 40 weeks pregnant