The Principal Pregnancy Complications Resulting in Preterm Birth in Singleton and Twin Gestations

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Abstract
Preterm birth is the major cause of perinatal mortality for both singleton and twin gestations in the United States; most preterm birth prevention programs are primarily structured to detect and treat preterm labor. Most of these programs have had limited success, and the preterm birth rate for twins has remained well above that for singletons. Little attention has been paid to the question of whether the frequency of conditions that result in preterm twin delivery differs from those that result in the delivery of preterm singletons. Delivery records were reviewed for all 1,976 preterm (24–36 completed gestational weeks) singleton pregnancies and 221 preterm twin pregnancies delivered at the University of Connecticut Health Center, 1980–1989, to determine the primary complication that resulted in preterm delivery. Premature rupture of membranes was responsible for 46% of these singleton preterm deliveries, while the other causes were preterm labor with intact membranes (20%), pregnancy-induced hypertension (15%), antepartum hemorrhage (9%), and other maternal-fetal indications (10%). The five groups differed significantly in maternal and neonatal characteristics. The principal pregnancy complications resulting in preterm delivery of twins were preterm rupture of membranes (42%), preterm labor (31%), antepartum hemorrhage (4%), pregnancy-induced hypertension (11%), and other maternal-fetal indications (12%). Compared to preterm singletons, the preterm twins were significantly more likely to deliver because of preterm labor and less likely to deliver because of hemorrhage. Substantial reduction in the preterm birth rate requires programs tailored to the specific population and etiologies involved and should not solely address preterm labor.

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