17α-Hydroxyprogesterone Caproate for the Prevention of Adverse Neonatal Outcome in Multiple Pregnancies

Lim, Arianne C.; Schuit, Ewoud; Bloemenkamp, Kitty W. M.; Bernardus, Rob E.; Duvekot, Johannes J.; Erwich, Jan Jaap H. M.; Eyck, Jim van; Groenwold, Rolf H H; Hasaart, T. H. M.; Hummel, P; Kars, Michael; Kwee, Anneke; Oirschot, Charlotte M. van; Pampus, Maria G. van; Papatsonis, Dimitri; Porath, Martina; Spaanderman, Marc E. A.; Willekes, Christine; Wilpshaar, Janine; Mol, Ben Willem J.; Bruinse, Hein W.

doi:10.1097/aog.0b013e31822ad6aa

Cited by 82 publications

(46 citation statements)

References 12 publications

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“…28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 Eighteen studies provided data on both monochorionic and dichorionic,16 30 32 34 36 38 40 42 43 44 45 48 49 50 51 54 56 57 seven on only monochorionic,29 31 37 39 41 47 53 and seven on only dichorionic twin pregnancies 2833 35 46 52 55 58 Twenty three authors provided relevant unpublished data 16…”

Section: Resultsmentioning

confidence: 99%

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

Cheong-See

Schuit

Arroyo-Manzano

et al. 2016

BMJ

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194

150

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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; I2=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; I2=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; I2=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.

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Section: Resultsmentioning

confidence: 99%

“…33 35 46 52 55 58 Twenty three authors provided relevant unpublished data 1628 30 32 33 34 35 38 39 41 42 43 47 48 49 50 51 52 53 54 56 57 58…”

Section: Resultsmentioning

confidence: 99%

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

Cheong-See

Schuit

Arroyo-Manzano

et al. 2016

BMJ

Self Cite

194

150

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“…2). 16 -19 Five trials with multiples 13,14,[17][18][19] reported preterm birth at 32 weeks of gestation or less and 28 weeks of gestation or less with inconsistent findings at both cut points.…”

Section: Resultsmentioning

confidence: 94%

“…Three trials reported no significant difference in preterm births using a 37-week cut point. 13,14,17 Four trials 16 -19 reported the preterm birth risk at less than 35 weeks of gestation with inconsistent findings. The Bayesian meta-estimate combining the two twin trials is a RR of 1.05 (95% Bayesian credible interval 0.86 -1.24; Fig.…”

Section: Resultsmentioning

confidence: 97%

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Progestogens for Preterm Birth Prevention

Likis

Edwards

Andrews

et al. 2012

Obstetrics & Gynecology

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Progestogens prevent preterm birth when used in singleton pregnancies for women with a prior preterm birth. In contrast, evidence suggests lack of effectiveness for multiple gestations. Evidence supporting all other uses is insufficient to guide clinical care. Overall, clinicians and patients lack longer-term information to understand whether intervention has the ultimately desired outcome of preventing morbidity and promoting normal childhood development.

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Prenatal administration of progesterone for preventing preterm birth in women considered to be at risk of preterm birth

Flenady

Cincotta

et al. 2006

Cochrane Database of Systematic Reviews

134

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17α-Hydroxyprogesterone Caproate for the Prevention of Adverse Neonatal Outcome in Multiple Pregnancies

Abstract: ISRCTN Register, www.isrctn.org, ISRCTN40512715.

Cited by 82 publications

References 12 publications

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

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

Progestogens for Preterm Birth Prevention

Prenatal administration of progesterone for preventing preterm birth in women considered to be at risk of preterm birth

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