Total perinatal-related wastage in twin pregnancies.

The primary obstetric cause of total perinatal-related wastage (TPRW) in twin pregnancy was studied in a clearly defined population over a 3-year period. There were 77 deaths from 204 pairs of twins; the perinatal mortality rate (PMR) was 51/1,000 and TPRW was 189/1,000. Of the 77 deaths 52% were late abortions, 14% stillbirths, 10% early neonatal deaths, 18% late neonatal deaths and 5% perinatal-related infant deaths. The major obstetric factors leading to TPRW were spontaneous preterm labour (32%), antepartum haemorrhage (30%), infection (16%), unexplained intra-uterine death (10%) and hypertension (8%). The major factors responsible for perinatal-related loss in twin pregnancies are similar to the major factors in singleton pregnancies, but occur earlier in pregnancy. Rather than considering the primary causes of loss in twin pregnancies as a separate entity, we should direct our attention to solving the same obstetric factors responsible for initiating loss in both twin and singleton pregnancies.