{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T08:22:27Z","timestamp":1765959747313},"reference-count":28,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2014,5,29]],"date-time":"2014-05-29T00:00:00Z","timestamp":1401321600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2014,9]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the optimal gestational age at delivery for twins.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Database containing demographic, delivery, and pregnancy outcome data for over 600\u00a0000 births from 81 hospitals in <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>lberta, <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>anada.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>All twin births in <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>lberta, <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>anada, during 1992\u20132007, as recorded in the databases of the <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>lberta <jats:styled-content style=\"fixed-case\">P<\/jats:styled-content>erinatal <jats:styled-content style=\"fixed-case\">H<\/jats:styled-content>ealth <jats:styled-content style=\"fixed-case\">P<\/jats:styled-content>roject (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/www.aphp.ca\">www.aphp.ca<\/jats:ext-link>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The case files were reviewed for cause of death and any information regarding the gestational age at diagnosis of stillbirth. Multivariate logistic regression was used to examine the impact of potentially confounding factors. The \u2018fetus at risk\u2019 approach was used to evaluate the prospective risk of stillbirth. Competing risks of stillbirth and neonatal death were evaluated with a perinatal risk ratio.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of a total of 17\u00a0724 twin births there were 236 antepartum stillbirths, 26 intrapartum stillbirths, and 244 neonatal deaths. The rate of stillbirth peaked at 7.0\/1000 fetuses at risk at 38\u00a0weeks of gestation. On multivariate analysis, small for gestational age (odds ratio, <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 2.2; 95% confidence interval, 95%\u00a0<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.35\u20133.59), birthweight discrepancy &gt;20% (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 2.67, 95%\u00a0<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.42\u20135.03), and an interaction between these two variables (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 2.94, 95%\u00a0<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.31\u20136.59), were significant. The perinatal risk ratio suggested that the risks of delivery and expectant management were balanced at 36\u00a0weeks of gestation (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 0.6, 95%\u00a0<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.1\u20135.4), but the confidence interval included one, the null value, until 38\u00a0weeks of gestation (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 0.1, 95%\u00a0<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.02\u20130.40). The majority of stillbirths at term (14\/25) occurred in monochorionic diamniotic twins. The estimated risk of stillbirth in this group was 2.3\/1000 fetuses at risk at 37\u00a0weeks of gestation, and 17.4\/1000 fetuses at risk at 38\u00a0weeks of gestation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The balance of risk between neonatal death\/intrapartum stillbirth and antepartum stillbirth begins to favour delivery at 36\u00a0weeks of gestation, particularly in monochorionic diamniotic twins.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.12866","type":"journal-article","created":{"date-parts":[[2014,5,29]],"date-time":"2014-05-29T07:01:35Z","timestamp":1401346895000},"page":"1284-1290","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Stillbirth in twins, exploring the optimal gestational age for delivery: a retrospective cohort study"],"prefix":"10.1111","volume":"121","author":[{"given":"S","family":"Wood","sequence":"first","affiliation":[{"name":"Department of Obstetrics &amp; 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