{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T14:58:14Z","timestamp":1790089094508,"version":"4.0.1"},"reference-count":35,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2020,6,16]],"date-time":"2020-06-16T00:00:00Z","timestamp":1592265600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Twin pregnancies have a significantly higher perinatal mortality than singleton pregnancies. Current classification systems for perinatal death lack twin\u2010specific categories, potentially leading to loss of important information regarding cause of death. We introduce and test a classification system designed to assign a cause of death in twin pregnancies (CoDiT).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cross\u2010sectional study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Tertiary maternity unit in England with a perinatal pathology service.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A multidisciplinary panel designed CoDiT by adapting the most appropriate elements of singleton classification systems. The system was tested by assigning cause of death in 265 fetal and neonatal deaths from 144 twin pregnancies. Cause of death was validated by another obstetrician blinded to the original classification.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Inter\u2010rater, intra\u2010rater, inter\u2010disciplinary agreement and cause of death.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Cohen\u2019s Kappa demonstrated \u2018strong\u2019 (&gt;0.8) inter\u2010rater, intra\u2010rater and inter\u2010disciplinary agreement (95% CI 0.70\u20130.91). The commonest cause of death irrespective of chorionicity was the placenta; twin\u2010to\u2010twin transfusion syndrome (TTTS) was the commonest placental cause in monochorionic twins and acute chorioamnionitis in dichorionic twins.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This novel classification system records causes of death in twin pregnancies from postmortem reports with high inter\u2010user agreement. We highlight differences in aetiology of death between monochorionic and dichorionic twins.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>New classification system for #twin cause of death \u2018CoDiT\u2019 shows high rater agreement.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.16291","type":"journal-article","created":{"date-parts":[[2020,5,2]],"date-time":"2020-05-02T18:06:00Z","timestamp":1588442760000},"page":"1507-1515","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Cause of intrauterine and neonatal death in twin pregnancies (CoDiT): development of a novel classification system"],"prefix":"10.1111","volume":"127","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4132-4998","authenticated-orcid":false,"given":"N","family":"Gulati","sequence":"first","affiliation":[{"name":"Institute of Metabolism &amp; Systems Research College of Medical &amp; Dental Sciences University of Birmingham Birmingham UK"},{"name":"Fetal Medicine Centre Birmingham Women's &amp; 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Children's Foundation Trust Birmingham UK"},{"name":"Institute of Applied Health Research College of Medical &amp; Dental Sciences University of Birmingham Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9987-4223","authenticated-orcid":false,"given":"MD","family":"Kilby","sequence":"additional","affiliation":[{"name":"Institute of Metabolism &amp; Systems Research College of Medical &amp; Dental Sciences University of Birmingham Birmingham UK"},{"name":"Fetal Medicine Centre Birmingham Women's &amp; Children's Foundation Trust Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,6,16]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"Birth characteristics in England and Wales: 2017 Annual live births by sex ethnicity and month maternities by place of birth and with multiple births and stillbirths by age of parents and calendar quarter.London: Office of National Statistics."},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.4236\/ojog.2013.31017"},{"issue":"494","key":"e_1_2_6_4_1","first-page":"e1","article-title":"The pregnancy and long\u2010term neurodevelopmental outcome of monochorionic diamniotic twin gestations: a multicenter prospective cohort study from the first trimester onward","volume":"200","author":"Ortibus E","year":"2009","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2013.06.014"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2006.00923.x"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20107"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-9-22"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38629.587639.7C"},{"key":"e_1_2_6_10_1","first-page":"2009","article-title":"Seeking order amidst chaos: a systematic review of classification systems for causes of stillbirth and neonatal death, 2009\u20132014","volume":"16","author":"Leisher SH","year":"2016","journal-title":"BMC Pregnancy Childbirth"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-016-1040-7"},{"key":"e_1_2_6_12_1","unstructured":"The WHO application of ICD\u201010 to deaths during the perinatal period: ICD\u2010PM[https:\/\/www.who.int\/publications\u2010detail\/9789241549752]. 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