A population-based cohort study of stillbirth among twins in Lusaka, Zambia

Elizabeth M Stringer; Carla Chibwesha; Marie Stoner; Bellington Vwalika; Jessica Joseph; Benjamin H Chi; Eugene Kaunda; William Goodnight; Jeffrey S A Stringer

doi:10.1016/j.ijgo.2014.12.015

A population-based cohort study of stillbirth among twins in Lusaka, Zambia

Int J Gynaecol Obstet. 2015 Jul;130(1):74-8. doi: 10.1016/j.ijgo.2014.12.015. Epub 2015 Mar 22.

Authors

Elizabeth M Stringer¹, Carla Chibwesha², Marie Stoner³, Bellington Vwalika⁴, Jessica Joseph⁵, Benjamin H Chi⁶, Eugene Kaunda⁴, William Goodnight⁷, Jeffrey S A Stringer⁷

Affiliations

¹ Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: elizabeth_stringer@med.unc.edu.
² Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
³ Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁴ Department of Obstetrics and Gynaecology, University Teaching Hospital, Lusaka, Zambia.
⁵ Clinton Health Access Initiative, Boston, MA, USA.
⁶ Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
⁷ Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

PMID: 25862294
DOI: 10.1016/j.ijgo.2014.12.015

Abstract

Objective: To determine rates of stillbirth and the associated risk factors for stillbirth among twins delivered in Lusaka, Zambia.

Methods: A retrospective cohort analysis was conducted of singletons and twins delivered at 26 public sector facilities between February 1, 2006, and May 31, 2013. Data were obtained from the Zambian Electronic Perinatal Record System. Risk of stillbirth was estimated using logistic regression.

Results: Overall, 260 657 singletons and 4021 twin pairs were included. There were 5105 stillbirths; 317 twins were stillborn. The crude stillbirth rate for twins was 39.4 per 1000 births (95% confidence interval [CI] 35.2-43.7) whereas the rate for singletons was 18.4 per 1000 births (95% CI 17.9-18.9; P<0.001). Factors associated with stillbirth among twins were increased interval between delivery (>60 minutes), low birth weight (<2500 g), birth order (being the second-born), and difference in birth weights (>30% discordance).

Conclusion: Twins were at an increased risk of stillbirth. Improved understanding of factors associated with stillbirth in this population could help to improve perinatal outcomes globally.

Keywords: Africa; Stillbirth; Twins; Urban; Zambia.

Publication types

Multicenter Study

MeSH terms

Birth Order*
Birth Weight*
Delivery, Obstetric
Female
Gestational Age
Humans
Infant, Newborn
Logistic Models
Pregnancy
Pregnancy, Twin*
Retrospective Studies
Risk Factors
Stillbirth / epidemiology*
Twins
Zambia / epidemiology