TY - JOUR
T1 - Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis
AU - Cheong-See, Fiona
AU - Schuit, Ewoud
AU - Arroyo-Manzano, David
AU - Khalil, Asma
AU - Barrett, Jon
AU - Joseph, K. S.
AU - Asztalos, Elizabeth
AU - Hack, Karien
AU - Lewi, Liesbeth
AU - Lim, Arianne
AU - Liem, Sophie
AU - Norman, Jane E.
AU - Morrison, John
AU - Combs, C. Andrew
AU - Garite, Thomas J.
AU - Maurel, Kimberly
AU - Serra, Vicente
AU - Perales, Alfredo
AU - Rode, Line
AU - Worda, Katharina
AU - Nassar, Anwar
AU - Aboulghar, Mona
AU - Rouse, Dwight
AU - Thom, Elizabeth
AU - Breathnach, Fionnuala
AU - Nakayama, Soichiro
AU - Russo, Francesca Maria
AU - Robinson, Julian N.
AU - Dodd, Jodie M.
AU - Newman, Roger B.
AU - Bhattacharya, Sohinee
AU - Tang, Selphee
AU - Mol, Ben Willem J.
AU - Zamora, Javier
AU - Thilaganathan, Basky
AU - Thangaratinam, Shakila
PY - 2016/9/6
Y1 - 2016/9/6
N2 - To determine the risks of stillbirth and neonatal complications by gestational age in uncomplicated monochorionic and dichorionic twin pregnancies.Systematic review and meta-analysis.Medline, Embase, and Cochrane databases (until December 2015).Databases were searched without language restrictions for studies of women with uncomplicated twin pregnancies that reported rates of stillbirth and neonatal outcomes at various gestational ages. Pregnancies with unclear chorionicity, monoamnionicity, and twin to twin transfusion syndrome were excluded. Meta-analyses of observational studies and cohorts nested within randomised studies were undertaken. Prospective risk of stillbirth was computed for each study at a given week of gestation and compared with the risk of neonatal death among deliveries in the same week. Gestational age specific differences in risk were estimated for stillbirths and neonatal deaths in monochorionic and dichorionic twin pregnancies after 34 weeks' gestation.32 studies (29?685 dichorionic, 5486 monochorionic pregnancies) were included. In dichorionic twin pregnancies beyond 34 weeks (15 studies, 17?830 pregnancies), the prospective weekly risk of stillbirths from expectant management and the risk of neonatal death from delivery were balanced at 37 weeks' gestation (risk difference 1.2/1000, 95% confidence interval -1.3 to 3.6; I(2)=0%). Delay in delivery by a week (to 38 weeks) led to an additional 8.8 perinatal deaths per 1000 pregnancies (95% confidence interval 3.6 to 14.0/1000; I(2)=0%) compared with the previous week. In monochorionic pregnancies beyond 34 weeks (13 studies, 2149 pregnancies), there was a trend towards an increase in stillbirths compared with neonatal deaths after 36 weeks, with an additional 2.5 per 1000 perinatal deaths, which was not significant (-12.4 to 17.4/1000; I(2)=0%). The rates of neonatal morbidity showed a consistent reduction with increasing gestational age in monochorionic and dichorionic pregnancies, and admission to the neonatal intensive care unit was the commonest neonatal complication. The actual risk of stillbirth near term might be higher than reported estimates because of the policy of planned delivery in twin pregnancies.To minimise perinatal deaths, in uncomplicated dichorionic twin pregnancies delivery should be considered at 37 weeks' gestation; in monochorionic pregnancies delivery should be considered at 36 weeks.PROSPERO CRD42014007538.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
AB - To determine the risks of stillbirth and neonatal complications by gestational age in uncomplicated monochorionic and dichorionic twin pregnancies.Systematic review and meta-analysis.Medline, Embase, and Cochrane databases (until December 2015).Databases were searched without language restrictions for studies of women with uncomplicated twin pregnancies that reported rates of stillbirth and neonatal outcomes at various gestational ages. Pregnancies with unclear chorionicity, monoamnionicity, and twin to twin transfusion syndrome were excluded. Meta-analyses of observational studies and cohorts nested within randomised studies were undertaken. Prospective risk of stillbirth was computed for each study at a given week of gestation and compared with the risk of neonatal death among deliveries in the same week. Gestational age specific differences in risk were estimated for stillbirths and neonatal deaths in monochorionic and dichorionic twin pregnancies after 34 weeks' gestation.32 studies (29?685 dichorionic, 5486 monochorionic pregnancies) were included. In dichorionic twin pregnancies beyond 34 weeks (15 studies, 17?830 pregnancies), the prospective weekly risk of stillbirths from expectant management and the risk of neonatal death from delivery were balanced at 37 weeks' gestation (risk difference 1.2/1000, 95% confidence interval -1.3 to 3.6; I(2)=0%). Delay in delivery by a week (to 38 weeks) led to an additional 8.8 perinatal deaths per 1000 pregnancies (95% confidence interval 3.6 to 14.0/1000; I(2)=0%) compared with the previous week. In monochorionic pregnancies beyond 34 weeks (13 studies, 2149 pregnancies), there was a trend towards an increase in stillbirths compared with neonatal deaths after 36 weeks, with an additional 2.5 per 1000 perinatal deaths, which was not significant (-12.4 to 17.4/1000; I(2)=0%). The rates of neonatal morbidity showed a consistent reduction with increasing gestational age in monochorionic and dichorionic pregnancies, and admission to the neonatal intensive care unit was the commonest neonatal complication. The actual risk of stillbirth near term might be higher than reported estimates because of the policy of planned delivery in twin pregnancies.To minimise perinatal deaths, in uncomplicated dichorionic twin pregnancies delivery should be considered at 37 weeks' gestation; in monochorionic pregnancies delivery should be considered at 36 weeks.PROSPERO CRD42014007538.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
U2 - 10.1136/bmj.i4353
DO - 10.1136/bmj.i4353
M3 - Article
C2 - 27599496
SN - 1756-1833
VL - 354
JO - BMJ
JF - BMJ
M1 - i4353
ER -