Effect of delayed interval delivery of remaining fetus(es) in multiple pregnancies on survival: a systematic review and meta-analysis
The management of the pregnancy after delivery of the first fetus during a second-trimester miscarriage or very early preterm birth has not been well defined. The objective of the study was to evaluate whether delayed interval delivery of the remaining fetus(es) in twins/triplets is associated with...
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| Veröffentlicht in: | American journal of obstetrics and gynecology 2020-04, Vol.222 (4), p.306-319.e18 |
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| creator | Cheung, Ka Wang Seto, Mimi Tin Yan Wang, Weilan Lai, Carman Wing Sze Kilby, Mark D. Ng, Ernest Hung Yu |
| description | The management of the pregnancy after delivery of the first fetus during a second-trimester miscarriage or very early preterm birth has not been well defined.
The objective of the study was to evaluate whether delayed interval delivery of the remaining fetus(es) in twins/triplets is associated with improved survival, when compared with immediate delivery, after miscarriage or very preterm birth of the first fetus in multiple pregnancy.
PubMed, MEDLINE, and Cochrane Library were systematically searched through January 2019.
The following eligibility criteria applied: full-text original article; included at least 5 cases of delayed interval delivery for remaining fetus(es); and reported the survival rate of the first-born and the remaining fetus(es).
K.W.C. and W.W. searched, screened, and reviewed the articles. The quality of the studies was assessed according to the Strengthening the Reporting of Observational studies in Epidemiology checklist. If possible, data were stratified for assigned chorionicity. Effect sizes were pooled through a meta-analysis.
A total of 2295 published article and abstracts were identified. Only 16 studies met inclusion criteria. Meta-analysis of 492 pregnancies (432 twins [88%], 56 triplets [11%], 3 quadruplets and 1 quintuplets) showed that delayed interval delivery significantly improved the perinatal survival of remaining fetus(es) compared with the first born (odds ratio, 5.22, 95% confidence interval, 2.95–9.25, I2 = 53%), before 20+0 weeks (odds ratio, 6.32, 95% confidence interval, 1.99–20.13, I2 = 0%), between 20+0 and 23+6 weeks (odds ratio, 3.31, 95% confidence interval, 1.95–5.63, I2 = 0%), and after 24+0 weeks (odds ratio, 1.92, 95% confidence interval, 1.21–3.05, I2 = 0%), in dichorionic twin pregnancy (odds ratio, 14.89, 95% confidence interval, 6.19–35.84, I2 = 0%), and unselected triplet pregnancy (odds ratio, 2.33, 95% confidence interval, 1.02–5.32, I2 = 0%. ). Among the survivors, there were no significant differences in the short-term and long-term neonatal morbidities between the first-born and the remaining fetus(es). Serious maternal morbidity was reported in 39% of pregnancy after delayed interval delivery (71 of 183). In addition, 2 cases were managed by postpartum hysterectomy and 1 reported postoperative uterovaginal fistula. There were no recorded cases of maternal mortality.
Delayed interval delivery when a fetus has delivered in a multiple pregnancy is an effective management option to increase the |
| doi_str_mv | 10.1016/j.ajog.2019.07.046 |
| format | Article |
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The objective of the study was to evaluate whether delayed interval delivery of the remaining fetus(es) in twins/triplets is associated with improved survival, when compared with immediate delivery, after miscarriage or very preterm birth of the first fetus in multiple pregnancy.
PubMed, MEDLINE, and Cochrane Library were systematically searched through January 2019.
The following eligibility criteria applied: full-text original article; included at least 5 cases of delayed interval delivery for remaining fetus(es); and reported the survival rate of the first-born and the remaining fetus(es).
K.W.C. and W.W. searched, screened, and reviewed the articles. The quality of the studies was assessed according to the Strengthening the Reporting of Observational studies in Epidemiology checklist. If possible, data were stratified for assigned chorionicity. Effect sizes were pooled through a meta-analysis.
A total of 2295 published article and abstracts were identified. Only 16 studies met inclusion criteria. Meta-analysis of 492 pregnancies (432 twins [88%], 56 triplets [11%], 3 quadruplets and 1 quintuplets) showed that delayed interval delivery significantly improved the perinatal survival of remaining fetus(es) compared with the first born (odds ratio, 5.22, 95% confidence interval, 2.95–9.25, I2 = 53%), before 20+0 weeks (odds ratio, 6.32, 95% confidence interval, 1.99–20.13, I2 = 0%), between 20+0 and 23+6 weeks (odds ratio, 3.31, 95% confidence interval, 1.95–5.63, I2 = 0%), and after 24+0 weeks (odds ratio, 1.92, 95% confidence interval, 1.21–3.05, I2 = 0%), in dichorionic twin pregnancy (odds ratio, 14.89, 95% confidence interval, 6.19–35.84, I2 = 0%), and unselected triplet pregnancy (odds ratio, 2.33, 95% confidence interval, 1.02–5.32, I2 = 0%. ). Among the survivors, there were no significant differences in the short-term and long-term neonatal morbidities between the first-born and the remaining fetus(es). Serious maternal morbidity was reported in 39% of pregnancy after delayed interval delivery (71 of 183). In addition, 2 cases were managed by postpartum hysterectomy and 1 reported postoperative uterovaginal fistula. There were no recorded cases of maternal mortality.
Delayed interval delivery when a fetus has delivered in a multiple pregnancy is an effective management option to increase the survival rate of the remaining fetus(es). About 39% of women may experience morbidity following this management option.</description><identifier>ISSN: 0002-9378</identifier><identifier>EISSN: 1097-6868</identifier><identifier>DOI: 10.1016/j.ajog.2019.07.046</identifier><identifier>PMID: 31394069</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Abortion, Spontaneous - mortality ; Abortion, Spontaneous - therapy ; antibiotics ; cerclage ; Delivery, Obstetric ; dichorionic ; Female ; Gestational Age ; Humans ; Infant, Newborn ; monochorionic ; Pregnancy ; Pregnancy Trimester, Second ; Pregnancy, Multiple ; Premature Birth - mortality ; Premature Birth - therapy ; preterm birth ; preterm delivery ; Survival Rate ; Time Factors ; triplet ; twin</subject><ispartof>American journal of obstetrics and gynecology, 2020-04, Vol.222 (4), p.306-319.e18</ispartof><rights>2019</rights><rights>Crown Copyright © 2019. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c400t-c08f21d269045b21beb646e013313bfa18a31b156c373026f118a47b04aec9213</citedby><cites>FETCH-LOGICAL-c400t-c08f21d269045b21beb646e013313bfa18a31b156c373026f118a47b04aec9213</cites><orcidid>0000-0001-7435-8169 ; 0000-0003-1207-6494</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002937819309585$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31394069$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cheung, Ka Wang</creatorcontrib><creatorcontrib>Seto, Mimi Tin Yan</creatorcontrib><creatorcontrib>Wang, Weilan</creatorcontrib><creatorcontrib>Lai, Carman Wing Sze</creatorcontrib><creatorcontrib>Kilby, Mark D.</creatorcontrib><creatorcontrib>Ng, Ernest Hung Yu</creatorcontrib><title>Effect of delayed interval delivery of remaining fetus(es) in multiple pregnancies on survival: a systematic review and meta-analysis</title><title>American journal of obstetrics and gynecology</title><addtitle>Am J Obstet Gynecol</addtitle><description>The management of the pregnancy after delivery of the first fetus during a second-trimester miscarriage or very early preterm birth has not been well defined.
The objective of the study was to evaluate whether delayed interval delivery of the remaining fetus(es) in twins/triplets is associated with improved survival, when compared with immediate delivery, after miscarriage or very preterm birth of the first fetus in multiple pregnancy.
PubMed, MEDLINE, and Cochrane Library were systematically searched through January 2019.
The following eligibility criteria applied: full-text original article; included at least 5 cases of delayed interval delivery for remaining fetus(es); and reported the survival rate of the first-born and the remaining fetus(es).
K.W.C. and W.W. searched, screened, and reviewed the articles. The quality of the studies was assessed according to the Strengthening the Reporting of Observational studies in Epidemiology checklist. If possible, data were stratified for assigned chorionicity. Effect sizes were pooled through a meta-analysis.
A total of 2295 published article and abstracts were identified. Only 16 studies met inclusion criteria. Meta-analysis of 492 pregnancies (432 twins [88%], 56 triplets [11%], 3 quadruplets and 1 quintuplets) showed that delayed interval delivery significantly improved the perinatal survival of remaining fetus(es) compared with the first born (odds ratio, 5.22, 95% confidence interval, 2.95–9.25, I2 = 53%), before 20+0 weeks (odds ratio, 6.32, 95% confidence interval, 1.99–20.13, I2 = 0%), between 20+0 and 23+6 weeks (odds ratio, 3.31, 95% confidence interval, 1.95–5.63, I2 = 0%), and after 24+0 weeks (odds ratio, 1.92, 95% confidence interval, 1.21–3.05, I2 = 0%), in dichorionic twin pregnancy (odds ratio, 14.89, 95% confidence interval, 6.19–35.84, I2 = 0%), and unselected triplet pregnancy (odds ratio, 2.33, 95% confidence interval, 1.02–5.32, I2 = 0%. ). Among the survivors, there were no significant differences in the short-term and long-term neonatal morbidities between the first-born and the remaining fetus(es). Serious maternal morbidity was reported in 39% of pregnancy after delayed interval delivery (71 of 183). In addition, 2 cases were managed by postpartum hysterectomy and 1 reported postoperative uterovaginal fistula. There were no recorded cases of maternal mortality.
Delayed interval delivery when a fetus has delivered in a multiple pregnancy is an effective management option to increase the survival rate of the remaining fetus(es). About 39% of women may experience morbidity following this management option.</description><subject>Abortion, Spontaneous - mortality</subject><subject>Abortion, Spontaneous - therapy</subject><subject>antibiotics</subject><subject>cerclage</subject><subject>Delivery, Obstetric</subject><subject>dichorionic</subject><subject>Female</subject><subject>Gestational Age</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>monochorionic</subject><subject>Pregnancy</subject><subject>Pregnancy Trimester, Second</subject><subject>Pregnancy, Multiple</subject><subject>Premature Birth - mortality</subject><subject>Premature Birth - therapy</subject><subject>preterm birth</subject><subject>preterm delivery</subject><subject>Survival Rate</subject><subject>Time Factors</subject><subject>triplet</subject><subject>twin</subject><issn>0002-9378</issn><issn>1097-6868</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kctu1DAUhi0EokPhBVggL8si4fgyToLYoKpcpEpsYG05zvHIo8QZbGeqPADvjaMpLLuyfPz_n3Q-E_KWQc2AqQ_H2hznQ82BdTU0NUj1jOwYdE2lWtU-JzsA4FUnmvaKvErpuF15x1-SK8FEJ0F1O_Lnzjm0mc6ODjiaFQfqQ8Z4NuM28GeM6_YYcTI--HCgDvOSbjC9L0E6LWP2pxHpKeIhmGA9JjoHmpZ49oXxkRqa1pRLO3tbKGePD9SEgU6YTWWCGdfk02vywpkx4ZvH85r8-nL38_Zbdf_j6_fbz_eVlQC5stA6zgauOpD7nrMeeyUVAhNlod4Z1hrBerZXVjQCuHKsTGTTgzRoO87ENbm5cE9x_r1gynryyeI4moDzkjTnTZG0l0KWKL9EbZxTiuj0KfrJxFUz0Jt-fdSbfr3p19Door-U3j3yl37C4X_ln-8S-HQJYNmyuIg6FWXB4uBj-QY9zP4p_l80epe2</recordid><startdate>202004</startdate><enddate>202004</enddate><creator>Cheung, Ka Wang</creator><creator>Seto, Mimi Tin Yan</creator><creator>Wang, Weilan</creator><creator>Lai, Carman Wing Sze</creator><creator>Kilby, Mark D.</creator><creator>Ng, Ernest Hung Yu</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7435-8169</orcidid><orcidid>https://orcid.org/0000-0003-1207-6494</orcidid></search><sort><creationdate>202004</creationdate><title>Effect of delayed interval delivery of remaining fetus(es) in multiple pregnancies on survival: a systematic review and meta-analysis</title><author>Cheung, Ka Wang ; Seto, Mimi Tin Yan ; Wang, Weilan ; Lai, Carman Wing Sze ; Kilby, Mark D. ; Ng, Ernest Hung Yu</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c400t-c08f21d269045b21beb646e013313bfa18a31b156c373026f118a47b04aec9213</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Abortion, Spontaneous - mortality</topic><topic>Abortion, Spontaneous - therapy</topic><topic>antibiotics</topic><topic>cerclage</topic><topic>Delivery, Obstetric</topic><topic>dichorionic</topic><topic>Female</topic><topic>Gestational Age</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>monochorionic</topic><topic>Pregnancy</topic><topic>Pregnancy Trimester, Second</topic><topic>Pregnancy, Multiple</topic><topic>Premature Birth - mortality</topic><topic>Premature Birth - therapy</topic><topic>preterm birth</topic><topic>preterm delivery</topic><topic>Survival Rate</topic><topic>Time Factors</topic><topic>triplet</topic><topic>twin</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cheung, Ka Wang</creatorcontrib><creatorcontrib>Seto, Mimi Tin Yan</creatorcontrib><creatorcontrib>Wang, Weilan</creatorcontrib><creatorcontrib>Lai, Carman Wing Sze</creatorcontrib><creatorcontrib>Kilby, Mark D.</creatorcontrib><creatorcontrib>Ng, Ernest Hung Yu</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of obstetrics and gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cheung, Ka Wang</au><au>Seto, Mimi Tin Yan</au><au>Wang, Weilan</au><au>Lai, Carman Wing Sze</au><au>Kilby, Mark D.</au><au>Ng, Ernest Hung Yu</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of delayed interval delivery of remaining fetus(es) in multiple pregnancies on survival: a systematic review and meta-analysis</atitle><jtitle>American journal of obstetrics and gynecology</jtitle><addtitle>Am J Obstet Gynecol</addtitle><date>2020-04</date><risdate>2020</risdate><volume>222</volume><issue>4</issue><spage>306</spage><epage>319.e18</epage><pages>306-319.e18</pages><issn>0002-9378</issn><eissn>1097-6868</eissn><abstract>The management of the pregnancy after delivery of the first fetus during a second-trimester miscarriage or very early preterm birth has not been well defined.
The objective of the study was to evaluate whether delayed interval delivery of the remaining fetus(es) in twins/triplets is associated with improved survival, when compared with immediate delivery, after miscarriage or very preterm birth of the first fetus in multiple pregnancy.
PubMed, MEDLINE, and Cochrane Library were systematically searched through January 2019.
The following eligibility criteria applied: full-text original article; included at least 5 cases of delayed interval delivery for remaining fetus(es); and reported the survival rate of the first-born and the remaining fetus(es).
K.W.C. and W.W. searched, screened, and reviewed the articles. The quality of the studies was assessed according to the Strengthening the Reporting of Observational studies in Epidemiology checklist. If possible, data were stratified for assigned chorionicity. Effect sizes were pooled through a meta-analysis.
A total of 2295 published article and abstracts were identified. Only 16 studies met inclusion criteria. Meta-analysis of 492 pregnancies (432 twins [88%], 56 triplets [11%], 3 quadruplets and 1 quintuplets) showed that delayed interval delivery significantly improved the perinatal survival of remaining fetus(es) compared with the first born (odds ratio, 5.22, 95% confidence interval, 2.95–9.25, I2 = 53%), before 20+0 weeks (odds ratio, 6.32, 95% confidence interval, 1.99–20.13, I2 = 0%), between 20+0 and 23+6 weeks (odds ratio, 3.31, 95% confidence interval, 1.95–5.63, I2 = 0%), and after 24+0 weeks (odds ratio, 1.92, 95% confidence interval, 1.21–3.05, I2 = 0%), in dichorionic twin pregnancy (odds ratio, 14.89, 95% confidence interval, 6.19–35.84, I2 = 0%), and unselected triplet pregnancy (odds ratio, 2.33, 95% confidence interval, 1.02–5.32, I2 = 0%. ). Among the survivors, there were no significant differences in the short-term and long-term neonatal morbidities between the first-born and the remaining fetus(es). Serious maternal morbidity was reported in 39% of pregnancy after delayed interval delivery (71 of 183). In addition, 2 cases were managed by postpartum hysterectomy and 1 reported postoperative uterovaginal fistula. There were no recorded cases of maternal mortality.
Delayed interval delivery when a fetus has delivered in a multiple pregnancy is an effective management option to increase the survival rate of the remaining fetus(es). About 39% of women may experience morbidity following this management option.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31394069</pmid><doi>10.1016/j.ajog.2019.07.046</doi><orcidid>https://orcid.org/0000-0001-7435-8169</orcidid><orcidid>https://orcid.org/0000-0003-1207-6494</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | American journal of obstetrics and gynecology, 2020-04, Vol.222 (4), p.306-319.e18 |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Abortion, Spontaneous - mortality Abortion, Spontaneous - therapy antibiotics cerclage Delivery, Obstetric dichorionic Female Gestational Age Humans Infant, Newborn monochorionic Pregnancy Pregnancy Trimester, Second Pregnancy, Multiple Premature Birth - mortality Premature Birth - therapy preterm birth preterm delivery Survival Rate Time Factors triplet twin |
| title | Effect of delayed interval delivery of remaining fetus(es) in multiple pregnancies on survival: a systematic review and meta-analysis |
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