Absolute risk: better basis for decision making

doi:10.1136/bmj.39164.420150.1F

BMJ 2007;334:651-652 (31 March), doi:10.1136/bmj.39164.420150.1F

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Perinatal death in twins

Absolute risk: better basis for decision making

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Smith et al's conclusion of threefold to fourfold increasedmortality in a second twin when born vaginally at term is arelative rather than an absolute risk.¹ There was an excesssecond twin all cause mortality of 73 infants, and an excesssecond twin anoxic mortality of 60 infants. Altogether therewere nearly 100 000 births, but the preterm rate (higher intwin births) was not stated, so there might have been 90 000full term confinements. This gives an increased mortality forthe second twin of 0.8 per 1000 births, and an increased anoxicmortality for the second twin of 0.67 per 1000 births. If caesareansection successfully avoided all the second twin mortality,1250 caesarean sections would be needed to save one infant.If caesarean section were only successful in preventing anoxicdeaths, 1500 caesarean sections would be needed to save oneinfant. Although this large number of . . . [Full text of this article]

Christopher Cheetham, consultant paediatrician (retired)

High Wycombe HP13 6QW

kimcheetham@btopenworld.com

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