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Cause of intrauterine and neonatal death in twin pregnancies (CoDiT): development of a novel classification system
Author(s) -
Gulati N,
Mackie FL,
Cox P,
Marton T,
Heazell AEP,
Morris RK,
Kilby MD
Publication year - 2020
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.16291
Subject(s) - medicine , obstetrics , cause of death , monochorionic twins , population , etiology , chorioamnionitis , twin pregnancy , obstetrics and gynaecology , maternal death , pregnancy , pediatrics , fetus , disease , environmental health , biology , genetics
Objective Twin pregnancies have a significantly higher perinatal mortality than singleton pregnancies. Current classification systems for perinatal death lack twin‐specific 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). Design Retrospective cross‐sectional study. Setting Tertiary maternity unit in England with a perinatal pathology service. Population 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. Methods 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. Main outcome measures Inter‐rater, intra‐rater, inter‐disciplinary agreement and cause of death. Results Cohen’s Kappa demonstrated ‘strong’ (>0.8) inter‐rater, intra‐rater and inter‐disciplinary agreement (95% CI 0.70–0.91). The commonest cause of death irrespective of chorionicity was the placenta; twin‐to‐twin transfusion syndrome (TTTS) was the commonest placental cause in monochorionic twins and acute chorioamnionitis in dichorionic twins. Conclusions This novel classification system records causes of death in twin pregnancies from postmortem reports with high inter‐user agreement. We highlight differences in aetiology of death between monochorionic and dichorionic twins. Tweetable abstract New classification system for #twin cause of death ‘CoDiT’ shows high rater agreement.