The epidemiology of perinatal mortality in multiple births.

The epidemiology of perinatal mortality in multiple pregnancies was investigated from data on 16,831 multiple births from New York City''s computerized vital records for 1978-1984. Twins had a sixfold higher rate of neonatal death and a threefold higher rate of fetal death during labor than had singleton infants. Much of this excess mortality can be explained by the lower birthweight distribution in twins: between 1,001 and 2,500 grams twins had birthweight-specific death rates equivalent to or substantially less than singletons. However, in infants of normal birthweights, twins had more than three times the mortality risk of singletons. For twins in vertex presentation between 1,001 and 3,000 grams, cesarean section did not appreciably reduce neonatal mortality risk. For twins in vertex presentation who weighted more than 3,000 grams the neonatal mortality rate was more than four times higher in vaginal deliveries than in cesarean sections (exact p = 0.034). Efforts to prevent intrapartum and neonatal mortality in multiple births should aim at reducing the incidence of low birthweight twins. More research is needed on the etiology of perinatal problems in normal birthweight twins (greater than or equal to 2,501 grams), especially on the effects of different modes of delivery.