Forskning
Udskriv Udskriv
Switch language
Region Hovedstaden - en del af Københavns Universitetshospital
Udgivet

Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  1. Re: Restoring Study 329: efficacy and harms of paroxetine and imipramine in treatment of major depression in adolescence

    Publikation: Bidrag til tidsskriftKommentar/debatForskningpeer review

  2. "Adaptive pathways" to drug authorisation: adapting to industry?

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  3. "Informed choice" in a time of too much medicine-no panacea for ethical difficulties

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  4. Antidepressants are addictive and increase the risk of relapse

    Publikation: Bidrag til tidsskriftLetterForskningpeer review

  5. Author's reply to Dubicka and colleagues and Stone

    Publikation: Bidrag til tidsskriftKommentar/debatForskningpeer review

  1. Magnetic Resonance Imaging: A New Tool to Optimize the Prediction of Fetal Anemia?

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  2. Longitudinal Brain and Body Growth in Fetuses With and Without Transposition of the Great Arteries

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  3. Is smoking heaviness causally associated with alcohol use? A Mendelian randomization study in four European cohorts

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  • Fiona Cheong-See
  • Ewoud Schuit
  • David Arroyo-Manzano
  • Asma Khalil
  • Jon Barrett
  • K S Joseph
  • Elizabeth Asztalos
  • Karien Hack
  • Liesbeth Lewi
  • Arianne Lim
  • Sophie Liem
  • Jane E Norman
  • John Morrison
  • C Andrew Combs
  • Thomas J Garite
  • Kimberly Maurel
  • Vicente Serra
  • Alfredo Perales
  • Line Rode
  • Katharina Worda
  • Anwar Nassar
  • Mona Aboulghar
  • Dwight Rouse
  • Elizabeth Thom
  • Fionnuala Breathnach
  • Soichiro Nakayama
  • Francesca Maria Russo
  • Julian N Robinson
  • Jodie M Dodd
  • Roger B Newman
  • Sohinee Bhattacharya
  • Selphee Tang
  • Ben Willem J Mol
  • Javier Zamora
  • Basky Thilaganathan
  • Shakila Thangaratinam
  • Global Obstetrics Network (GONet) Collaboration
Vis graf over relationer

OBJECTIVE: To determine the risks of stillbirth and neonatal complications by gestational age in uncomplicated monochorionic and dichorionic twin pregnancies.

DESIGN: Systematic review and meta-analysis.

DATA SOURCES: Medline, Embase, and Cochrane databases (until December 2015).

REVIEW METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42014007538.

OriginalsprogEngelsk
TidsskriftBritish Medical Journal
Vol/bind354
Sider (fra-til)i4353
ISSN0959-8146
StatusUdgivet - 6 sep. 2016

ID: 49865143