Evidence map›Paper›PMID 30453908›Full record

ArticleBMC pregnancy and childbirth2018

Perinatal outcomes in twin pregnancies complicated by maternal morbidity: evidence from the WHO Multicountry Survey on Maternal and Newborn Health.

Danielly S Santana, Carla Silveira, Maria L Costa, Renato T Souza, Fernanda G Surita, João P Souza, Syeda Batool Mazhar, Kapila Jayaratne, Zahida Qureshi, Maria H Sousa and 3 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC pregnancy and childbirth, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 88 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
88citing papers in PubMed, 9 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

88 citing papers in PubMed, 9 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Pooled it
  9. Pooled it
  10. Trial
  11. Article
  12. Addressing multiple pregnancies in in vitro fertilization-embryo transfer: Current status, challenges, and solutions.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026
    Review
  13. Article
  14. Article
  15. Article
  16. Article
  17. Article
  18. Article
  19. Article
  20. Article

28 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Danielly S SantanaDepartment of Obstetrics and Gynecology, University of Campinas, Alexander Fleming Street, 101, Campinas, SP, 13083-891, Brazil.
Carla SilveiraDepartment of Obstetrics and Gynecology, University of Campinas, Alexander Fleming Street, 101, Campinas, SP, 13083-891, Brazil.
Maria L CostaDepartment of Obstetrics and Gynecology, University of Campinas, Alexander Fleming Street, 101, Campinas, SP, 13083-891, Brazil.
Renato T SouzaDepartment of Obstetrics and Gynecology, University of Campinas, Alexander Fleming Street, 101, Campinas, SP, 13083-891, Brazil.
Fernanda G SuritaDepartment of Obstetrics and Gynecology, University of Campinas, Alexander Fleming Street, 101, Campinas, SP, 13083-891, Brazil.
João P SouzaUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
Syeda Batool MazharPakistan Institute of Medical Sciences, Islamabad, Pakistan.
Kapila JayaratneMaternal & Child Morbidity & Mortality Surveillance Unit, Family Health Bureau, Ministry of Health, Colombo, Sri Lanka.
Zahida QureshiDepartment of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya.
Maria H SousaDepartment of Public Health, Jundiai Medical School, Jundiai, Brazil.
Joshua P VogelUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
José G CecattiDepartment of Obstetrics and Gynecology, University of Campinas, Alexander Fleming Street, 101, Campinas, SP, 13083-891, Brazil. cecatti@unicamp.br.ORCID http://orcid.org/0000-0003-1285-8445
WHO Multi-Country Survey on Maternal and Newborn Health Research Network

Funding

World Health Organization 001
6 · The paper itself

Abstract

backgroundTwin pregnancy was associated with significantly higher rates of adverse neonatal and perinatal outcomes, especially for the second twin. In addition, the maternal complications (potentially life-threatening conditions-PLTC, maternal near miss-MNM, and maternal mortality-MM) are directly related to twin pregnancy and independently associated with adverse perinatal outcome. The objective of the preset study is to evaluate perinatal outcomes associated with twin pregnancies, stratified by severe maternal morbidity and order of birth.

methodsSecondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS), a cross-sectional study implemented in 29 countries. Data from 8568 twin deliveries were compared with 308,127 singleton deliveries. The occurrence of adverse perinatal outcomes and maternal complications were assessed. Factors independently associated with adverse perinatal outcomes were reported with adjusted PR (Prevalence Ratio) and 95%CI.

resultsThe occurrence of severe maternal morbidity and maternal death was significantly higher among twin compared to singleton pregnancies in all regions. Twin deliveries were associated with higher rates of preterm delivery (37.1%), Apgar scores less than 7 at 5th minute (7.8 and 10.1% respectively for first and second twins), low birth weight (53.2% for the first and 61.1% for the second twin), stillbirth (3.6% for the first and 5.7% for the second twin), early neonatal death (3.5% for the first and 5.2% for the second twin), admission to NICU (23.6% for the first and 29.3% for the second twin) and any adverse perinatal outcomes (67% for the first twin and 72.3% for the second). Outcomes were consistently worse for the second twin across all outcomes. Poisson multiple regression analysis identified several factors independently associated with an adverse perinatal outcome, including both maternal complications and twin pregnancy.

conclusionTwin pregnancy is significantly associated with severe maternal morbidity and with worse perinatal outcomes, especially for the second twin.

Indexed as

Pregnancy, TwinAdultApgar ScoreCross-Sectional StudiesFemaleHealth SurveysHospitalizationHumansInfant HealthInfant, Low Birth WeightInfant, NewbornIntensive Care Units, NeonatalMaternal HealthMaternal MortalityPoisson DistributionPregnancyMaternal morbidityPerinatal outcomeTwin pregnancy

Identifiers

PMID30453908
PMCPMC6245698

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.