Does Delayed Delivery of the Second Twin Improve Survival?
BACKGROUND AND PURPOSE:
Research is limited as to whether delaying delivery of remaining fetuses improves survival when the first fetus has been delivered relatively early in pregnancy
Benefits include delivery at a later gestational age
Risks include chorioamnionitis
Cheung et al. (AJOG, 2019) investigated the association between delayed delivery of the remaining fetus(es) in twin or triplet pregnancies following preterm birth of the first fetus and perinatal survival and other outcomes
Systematic review and meta-analysis
PubMed, MEDLINE and Cochrane Library through January 2019
Studies had to include ≥5 cases and reported survival rates of the first born and remaining fetus(es)
Data synthesis and analysis
Two authors searched, screened and reviewed the articles
Data were stratified for chorionicity and gestational age
Effect sizes were pooled through meta-analysis
Survival of remaining fetuses compared to first born (proxy for the likely outcome if the remaining fetus had been delivered immediately)
Delayed interval delivery significantly improved perinatal survival of remaining fetus(es)
Compared to the first born: Odds ratio (OR) 5.22 (95% CI, 2.95 to 9.25)
Stratified by gestational age of first delivery
First delivery before 20w0d: OR 6.32 (95% CI, 1.99 to 20.13)
First delivery between 20w0d and 23w6d: OR 3.31 (95% CI, 1.95 to 5.63)
First delivery >24w0d: OR 1.92 (95% CI, 1.21 to 3.05)
Stratified by chorionicity
Dichorionic twin pregnancy: OR 14.89 (95% CI, 6.19 to 35.84)
Triplet pregnancy: OR 2.33 (95% CI, 1.02 to 5.32)
There was no difference in short term (e.g., NEC) vs long term (e.g., neurodevelopmental delay) morbidities between first born and surviving remaining fetuses (however ‘n’ was small, and caution warranted)
Maternal morbidity following delayed delivery: 39%
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