Optimal Timing of Delivery Based on the Risk of Stillbirth and Infant Death Associated with Each Additional Week of Expectant Management in Multiple Pregnancies: a National Cohort Study of Koreans

Ko, Hyun Sun; Choi, Sae-Kyung; Wie, Jeong Ha; Park, In Yang; Park, Yong Gyu; Shin, Jong Chul

doi:10.3346/jkms.2018.33.e80

Cited by 8 publications

(11 citation statements)

References 21 publications

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“…Multiple pregnancies were also associated with higher odds of stillbirth. This is in keeping with other studies (46,47). Multiple gestation is associated with increased risk of other pregnancy complications that can result in stillbirth including fetal abnormalities, twin to twin transfusion and intrauterine growth restriction.…”

Section: Discussionsupporting

confidence: 91%

Association Between Obstetric and Medical Risk Factors With Stillbirths in 4 Tertiary Hospitals in a Low Income Country

Gwako

Obimbo

Gichangi

et al. 2020

Preprint

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Background The burden of stillbirth in Africa is high. The burden of stillbirth in Kenya is unknown, and very few studies have investigated the association between medical and obstetric risk factors and the occurrence of stillbirth in a Kenyan setting. The aim of this study was to evaluate the association between obstetric and medical risk factors with stillbirths in Nairobi, Kenya. This information is key to the healthcare system while formulating policies and interventions to mitigate preventable stillbirths. Methods This was a case-control study conducted in four Kenyan hospitals between August 2018 and April 2019. Two hundred and fourteen women with stillbirths and 428 with livebirths > 28 weeks were enrolled and evaluated. Data was collected via interviews and data abstraction from medical records. The outcome variables were stillbirth and livebirth; the exposure variables were sociodemographic characteristics, medical and obstetric risk factors. Sociodemographic characteristics were compared using the two-sample t-test for continuous variables and Chi-square or Fisher's exact tests for categorical variables. The association between the medical and obstetric risk factors with stillbirth was assessed using univariate and multivariate analysis using logistic regression. Statistical significance was defined as a two-tailed p-value of ≤0.05. Results Mothers with obstetric complications had higher odds of stillbirth: pre-eclampsia (OR 9.1, 95% CI 2.6–32.5, P = 0.001), eclampsia (OR 9.2, 95% CI 2.6–32.5, P = 0.001), placenta previa (OR 8.6 95% CI 2.8–25.9, P = 0.001), abruptio placenta (OR 6.9 95% CI 2.2–21.3, P = 0.001), early preterm delivery 28-34weeks (OR 9.5, 95% CI 5.7–16), late preterm delivery between 34–37 weeks (OR 2.0 95% CI 1.3–3.3) and previous preterm birth (OR 4.7, 95% CI 1.2–18.7, P = 0.01). Women with gestational diabetes mellitus had a 11fold higher likelihood of a stillbirth, OR 11.5 95% CI 2.5–52, P = 0.001). There was no association between intrauterine growth restriction (IUGR), multiple gestation, congenital anomalies, previous stillbirth, previous abortion, HIV and anaemia with stillbirth. Conclusion: Our findings reiterate the significance of medical and obstetric complications in association with stillbirth in a Kenyan urban setting. Proper antepartum care and surveillance to identify and manage medical and obstetric conditions with a potential of causing stillbirth are recommended.

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Section: Discussionsupporting

confidence: 91%

Association Between Obstetric and Medical Risk Factors With Stillbirths in 4 Tertiary Hospitals in a Low Income Country

Gwako

Obimbo

Gichangi

et al. 2020

Preprint

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“…However, our prevalence is similar to that reported across sub-Saharan Africa, and lower than a reported 10.2% stillbirth prevalence among twins in one Nigerian study [24]. In contrast, the prevalence of stillbirth in twins in Botswana is higher than in high-income countries such as the United States (USA) (0.35%) [25] and South Korea (0.48%) [26]. The prevalence of stillbirth among singletons in our study is 2.4%, which is nearly 10 times greater than that among singletons in many high-income countries [27,28].…”

Section: 0%)supporting

confidence: 75%

“…where 60% of twin pregnancies have preterm births [6,7,28] surveillance of twin pregnancies after 34 weeks GA, at which time the risk of stillbirth and maternal complications begins to rise, may improve twin outcomes in Botswana [26]. Close monitoring for fetal growth concordance [34], screening for aneuploidy, which is more common among twin pregnancies and associated with higher risk of stillbirth [35,36], and clear delivery planning during antenatal care may also help to reduce adverse perinatal outcomes among twins.…”

Section: 0%)mentioning

confidence: 99%

Prevalence and Outcomes of Twin Pregnancies in Botswana: a National Birth Outcomes Surveillance Study

Isaacson

Diseko

Mayondi

et al. 2020

Preprint

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Background: Twin deliveries have a high risk of adverse birth outcomes, but most data comes from high-resource settings. The prevalence and outcomes of twin pregnancies in Botswana have not previously been reported. Methods: The Tsepamo Study conducted birth outcomes surveillance at 8 hospitals (~40% of all births in Botswana) from August 2014-June 2018 and up to 18 hospitals (~70% of all births in Botswana) from July 2018-March 2019. Maternal demographics, antenatal care visits, ultrasound reports, and infant delivery characteristics (including the number of infants delivered, gestational age (GA) at delivery, birthweight, and vital status at birth and discharge) were abstracted from maternity obstetric records. Log binomial regression models were fit to determine the relative risk (RR), adjusted risk (aRR), and 95% confidence intervals (95% CI) of adverse birth outcomes among twin compared with singleton pregnancies. Higher order multiples were excluded from analyses. Results: Between August 2014 and March 2019, 119,477 deliveries were recorded, including 1859 (1.6%) sets of twins. Women with twin pregnancies had a similar median number of antenatal care visits (9 vs. 10), but were more likely to deliver in a tertiary center (54.8% vs. 45.1%, p<0.001) and more likely to have a C-section (54.6% vs. 22.0%, p<0.001) than women with singletons. Adverse birth outcomes were notably higher in twins than in singletons. Compared with singletons, twin pregnancies had a higher risk of preterm delivery (<37 weeks GA) (47.6% vs. 16.7%, aRR 2.8, 95% CI 2.7, 2.9) and very preterm delivery (<32 weeks) (11.8% vs. 4.0%, aRR 3.0 95% CI 2.6, 3.4). Twin pregnancies were more likely than singletons to have at least one low-birthweight (77.1% vs. 13.6%, aRR 4.5, 95% CI 4.3, 4.6) or very low-birthweight (16.8% vs. 3.2%, aRR 5.2, 95% CI 4.7, 5.8) infant. Among all twin pregnancies, 128 (6.9%) had at least one stillborn infant compared with 2845 (2.4%) stillbirths among singletons (aRR 2.8, 95% CI 2.3, 3.3). Conclusion: Adverse birth outcomes are common among twins in Botswana, and are often severe. Interventions that allow for earlier identification of twin gestation and improved antenatal management of twin pregnancies may improve infant and child survival.

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“…The risk of child death after delivery gradually declined as pregnancies neared full term. This group recommended increased fetal surveillance after 34 weeks of gestation in multiple pregnancies [6].…”

Section: Risk Of Fetal Death In the Third Trimester For Twin Pregnanciesmentioning

confidence: 99%

“…Although the data about triplet pregnancies are still limited, and the monoamniotic and diamniotic triplets should be delivered between 32 + 0 and 32 + 6 weeks [38], most studies and guidelines suggest delivery time at no later than 36 weeks, even in uncomplicated triamniotic triplets [6,39,40]. The preferred delivery route is the cesarean section because vaginal delivery is associated with an increased risk of adverse outcomes if compared with the cesarean [41,42].…”

Section: Exceptional Situationsmentioning

confidence: 99%

Time and Mode of Delivery in Twin Pregnancies

Santana¹,

Corrêa²,

Bottura³

et al. 2019

Multiple Pregnancy - New Challenges

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There are many suitable recommendations for twin gestation term in the literature. In many protocols, resolution is recommended for dichorionic pregnancies around 38 weeks, at 36 weeks for monochorionic (devoid of complications) and at 32-34 weeks in cases of single amniotic chamber. The main risk associated with vaginal delivery is connected to the possibility of anoxia of the second twin. However, a cesarean delivery performed by non-cephalic presentation of the second twin is associated with increased maternal morbidity without improved neonatal outcome. The most important factors in the decision of the delivery mode include the presentation of the fetus, gestational age, and weight or the weight difference between the fetuses.

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Optimal Timing of Delivery Based on the Risk of Stillbirth and Infant Death Associated with Each Additional Week of Expectant Management in Multiple Pregnancies: a National Cohort Study of Koreans

Cited by 8 publications

References 21 publications

Association Between Obstetric and Medical Risk Factors With Stillbirths in 4 Tertiary Hospitals in a Low Income Country

Association Between Obstetric and Medical Risk Factors With Stillbirths in 4 Tertiary Hospitals in a Low Income Country

Prevalence and Outcomes of Twin Pregnancies in Botswana: a National Birth Outcomes Surveillance Study

Time and Mode of Delivery in Twin Pregnancies

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