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

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 Databas...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group Ltd. 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5013231/
https://www.ncbi.nlm.nih.gov/pubmed/27599496
http://dx.doi.org/10.1136/bmj.i4353
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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
author_facet 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
author_sort Cheong-See, Fiona
collection PubMed
description 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.
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spelling pubmed-50132312016-09-09 Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis 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 BMJ Research 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. BMJ Publishing Group Ltd. 2016-09-06 /pmc/articles/PMC5013231/ /pubmed/27599496 http://dx.doi.org/10.1136/bmj.i4353 Text en 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 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/.
spellingShingle Research
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
Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis
title Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis
title_full Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis
title_fullStr Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis
title_full_unstemmed Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis
title_short Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis
title_sort prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5013231/
https://www.ncbi.nlm.nih.gov/pubmed/27599496
http://dx.doi.org/10.1136/bmj.i4353
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