Should apparently uncomplicated monochorionic twins be delivered electively at 32 weeks?

Domingues, Ana Patrícia; Fonseca, Etelvina; Vasco, Elsa; Moura, Paulo

doi:10.3109/14767050903042579

Cited by 20 publications

(13 citation statements)

References 4 publications

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“…Thus, nine studies were included in the systematic review, reporting outcomes from 1,747 monochorionicdiamniotic pregnancies. 5,[9][10][11][12]15,[21][22][23] Figure 1 shows the flow process for included studies with seven from Europe and two from the United States. Four included a dichorionic control group.…”

Section: Resultsmentioning

confidence: 99%

“…All studies defined estimated fetal weight discordancy as 20% or 25%, but not all defined SGA. 9,21,24 Of those that did, all but one 15 defined SGA as the more liberal less than 10th centile. The use of Doppler evaluation was not uniform.…”

Section: Resultsmentioning

confidence: 99%

“…Some of the subsequent cohort studies confirmed risks approaching 2% or higher, whereas others found risks of 0.5% or less. [6][7][8][9][10][11] Controlled observational studies comparing monochorionicdiamniotic with dichorionic twins similarly reported conflicting results regarding any increased risk of stillbirth with hazard ratios ranging from 0.9 to 5.2. [11][12][13] Differences in antenatal surveillance strategy, definition of pathologies, and reporting methodology have rendered it difficult to assess the actual risks from individual studies.…”

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confidence: 90%

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Increased Stillbirth in Uncomplicated Monochorionic Twin Pregnancies

Danon

Sekar

Hack

et al. 2013

Obstetrics &Amp; Gynecology

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 90%

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Increased Stillbirth in Uncomplicated Monochorionic Twin Pregnancies

Danon

Sekar

Hack

et al. 2013

Obstetrics &Amp; Gynecology

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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%

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

Cheong-See

Schuit

Arroyo-Manzano

et al. 2016

BMJ

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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“…Otros estudios sugieren que hasta 30% de mortinatos podrían haberse evitado con interrupciones electivas entre la 34 y 35 semanas (69,70) . Estas observaciones se apoyan en el hecho que los gemelos monocoriónicos pueden beneficiarse de la interrupción electiva, y la vigilancia estrecha podría hacer diferencia (50) .…”

Section: Prevenciónunclassified

Muerte fetal intrauterina de uno de los gemelos

Rondón-Tapia

2018

Rev peru ginecol obstet.

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RESUMENLos embarazos múltiples, la mayoría de los cuales son gemelares, tienen un riesgo sustancialmente mayor de morbimortalidad fetal comparado con los embarazos únicos. La muerte fetal de uno de los gemelos en embarazos gemelares monocoriónicos es más frecuente que en embarazos gemelares dicoriónicos. La muerte fetal intrauterina ocurre en 1 a 7% de todos los embarazos gemelares y aumenta considerablemente la tasa de complicaciones del gemelo superviviente, incluyendo pérdida fetal, parto prematuro y daño de órgano final. La edad gestacional en que ocurre la muerte fetal intrauterina y la corionicidad de los embarazos múltiples son los dos factores más importantes al considerar los riesgos del gemelo superviviente. La morbimortalidad de estos embarazos puede disminuir con la identificación del embarazo de riesgo y la vigilancia prenatal intensiva. Los embarazos monocoriónicos son más difíciles de manejar y a menudo los embarazos se interrumpen entre las 34 y 36 semanas. Los embarazos dicoriónicos se pueden interrumpir más cerca del término. Palabras clave. Muerte intrauterina de un gemelo, Muerte fetal intrauterina, Embarazo gemelar. ABSTRACTMultiple pregnancies, most of which are twins, have a substantially increased risk of fetal morbidity and mortality compared to single pregnancies. The fetal death of one of the twins in monochorionic twin pregnancies is more frequent than in twin dichorionic pregnancies. Intrauterine fetal death occurs in 1-7% of all twin pregnancies and greatly increases the rate of complications of the surviving twin including fetal loss, preterm birth, and end organ damage. The gestational age at which intrauterine fetal death occurs and the chorionicity of the multiple pregnancy are the two most important factors when considering the risks of the surviving twin. The morbidity and mortality of these pregnancies may decrease with risk identification and intensive prenatal surveillance. Monochorionic pregnancies are more difficult to manage, and often pregnancies are interrupted at 34-36 weeks. Dichorionic pregnancies can be interrupted closer to term.

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Should apparently uncomplicated monochorionic twins be delivered electively at 32 weeks?

Abstract: In otherwise apparently uncomplicated monochorionic diamniotic pregnancies this prospective risk of fetal death after 32 weeks of gestation is lower than reported and similar to that of dichorionic pregnancies, so does not sustain the theory of elective preterm delivery.

Cited by 20 publications

References 4 publications

Increased Stillbirth in Uncomplicated Monochorionic Twin Pregnancies

Increased Stillbirth in Uncomplicated Monochorionic Twin Pregnancies

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

Muerte fetal intrauterina de uno de los gemelos

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