Prospective risk of stillbirth and neonatal complications in...
Prospective risk of stillbirth and neonatal complications in twin pregnancy: meta-analysis
Delivery of uncomplicated dichorionic pregnancies at 37 weeks and monochorionic pregnancies at 36 weeks should be considered to reduce perinatal mortality.
Cheong-See F, Shuit E, Arroyo-Manzano D, et al. Prospective risk of stillbirth and neonatal complications in twin pregnancy: systematic review and meta-analysis. BMJ 2016; 354:i4353.
Twin pregnancies have higher stillbirth rates compared to singleton pregnancies - up to 5 times and 13 times higher for dichorionic and monochorionic twins respectively.
Elective preterm delivery for twins from 34 weeks may prevent late stillbirth but may also increase the neonatal mortality and morbidity.
This study aimed to determine the optimal timing of delivery of twin pregnancies by comparing stillbirth with neonatal mortality rates from 34 weeks gestation.
A meta-analysis of 32 observational studies involving twin pregnancies with known chorionicity and without twin to twin transfusion syndrome was performed. The primary outcome was to determine the gestation where the risk of stillbirth was equivalent to the risk of neonatal death.
Data from 35,171 women with 29,685 dichorionic pregnancies and 5486 monochorionic pregnancies were analysed.
For dichorionic pregnancies the prospective risk of stillbirth and the risk of neonatal death from delivery were balanced at 37 weeks gestation, beyond which the risk of stillbirth significantly outweighed the risk of neonatal death.
For monochorionic pregnancies the perinatal risks were balanced at 36 weeks gestation, beyond which there was an increased trend towards higher stillbirth risk than neonatal death.
To minimise perinatal mortality in uncomplicated twin pregnancies, delivery should be considered at 37 weeks for dichorionic twins and 36 weeks for monochorionic twins.