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

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Harvard

Cheong-See, F, Schuit, E, Arroyo-Manzano, D, Khalil, A, Barrett, J, Joseph, KS, Asztalos, E, Hack, K, Lewi, L, Lim, A, Liem, S, Norman, JE, Morrison, J, Combs, CA, Garite, TJ, Maurel, K, Serra, V, Perales, A, Rode, L, Worda, K, Nassar, A, Aboulghar, M, Rouse, D, Thom, E, Breathnach, F, Nakayama, S, Russo, FM, Robinson, JN, Dodd, JM, Newman, RB, Bhattacharya, S, Tang, S, Mol, BWJ, Zamora, J, Thilaganathan, B, Thangaratinam, S & Global Obstetrics Network (GONet) Collaboration 2016, 'Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis' British Medical Journal, vol. 354, pp. i4353.

APA

Cheong-See, F., Schuit, E., Arroyo-Manzano, D., Khalil, A., Barrett, J., Joseph, K. S., ... Global Obstetrics Network (GONet) Collaboration (2016). Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis. British Medical Journal, 354, i4353.

CBE

Cheong-See F, Schuit E, Arroyo-Manzano D, Khalil A, Barrett J, Joseph KS, Asztalos E, Hack K, Lewi L, Lim A, Liem S, Norman JE, Morrison J, Combs CA, Garite TJ, Maurel K, Serra V, Perales A, Rode L, Worda K, Nassar A, Aboulghar M, Rouse D, Thom E, Breathnach F, Nakayama S, Russo FM, Robinson JN, Dodd JM, Newman RB, Bhattacharya S, Tang S, Mol BWJ, Zamora J, Thilaganathan B, Thangaratinam S, Global Obstetrics Network (GONet) Collaboration. 2016. Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis. British Medical Journal. 354:i4353.

MLA

Vancouver

Cheong-See F, Schuit E, Arroyo-Manzano D, Khalil A, Barrett J, Joseph KS et al. Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis. British Medical Journal. 2016 Sep 6;354:i4353.

Author

Cheong-See, Fiona ; Schuit, Ewoud ; Arroyo-Manzano, David ; Khalil, Asma ; Barrett, Jon ; Joseph, K S ; Asztalos, Elizabeth ; Hack, Karien ; Lewi, Liesbeth ; Lim, Arianne ; Liem, Sophie ; Norman, Jane E ; Morrison, John ; Combs, C Andrew ; Garite, Thomas J ; Maurel, Kimberly ; Serra, Vicente ; Perales, Alfredo ; Rode, Line ; Worda, Katharina ; Nassar, Anwar ; Aboulghar, Mona ; Rouse, Dwight ; Thom, Elizabeth ; Breathnach, Fionnuala ; Nakayama, Soichiro ; Russo, Francesca Maria ; Robinson, Julian N ; Dodd, Jodie M ; Newman, Roger B ; Bhattacharya, Sohinee ; Tang, Selphee ; Mol, Ben Willem J ; Zamora, Javier ; Thilaganathan, Basky ; Thangaratinam, Shakila ; Global Obstetrics Network (GONet) Collaboration. / Prospective risk of stillbirth and neonatal complications in twin pregnancies : systematic review and meta-analysis. In: British Medical Journal. 2016 ; Vol. 354. pp. i4353.

Bibtex

@article{c910f1d877c44fc897143e6f7c82a32d,
title = "Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis",
abstract = "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.",
keywords = "Journal Article",
author = "Fiona Cheong-See and Ewoud Schuit and David Arroyo-Manzano and Asma Khalil and Jon Barrett and Joseph, {K S} and Elizabeth Asztalos and Karien Hack and Liesbeth Lewi and Arianne Lim and Sophie Liem and Norman, {Jane E} and John Morrison and Combs, {C Andrew} and Garite, {Thomas J} and Kimberly Maurel and Vicente Serra and Alfredo Perales and Line Rode and Katharina Worda and Anwar Nassar and Mona Aboulghar and Dwight Rouse and Elizabeth Thom and Fionnuala Breathnach and Soichiro Nakayama and Russo, {Francesca Maria} and Robinson, {Julian N} and Dodd, {Jodie M} and Newman, {Roger B} and Sohinee Bhattacharya and Selphee Tang and Mol, {Ben Willem J} and Javier Zamora and Basky Thilaganathan and Shakila Thangaratinam and {Global Obstetrics Network (GONet) Collaboration}",
note = "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.",
year = "2016",
month = "9",
day = "6",
language = "English",
volume = "354",
pages = "i4353",
journal = "BMJ",
issn = "1756-1833",
publisher = "B M J Group",

}

RIS

TY - JOUR

T1 - Prospective risk of stillbirth and neonatal complications in twin pregnancies

T2 - 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

AU - Global Obstetrics Network (GONet) Collaboration

N1 - 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.

PY - 2016/9/6

Y1 - 2016/9/6

N2 - 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.

AB - 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.

KW - Journal Article

M3 - Journal article

VL - 354

SP - i4353

JO - BMJ

JF - BMJ

SN - 1756-1833

ER -

ID: 49865143