Elective birth at 37 weeks’ gestation for women with an uncomplicated twin pregnancy

Early birth at 37 weeks' gestation compared with ongoing expectant management for women with an uncomplicated twin pregnancy may not be associated with an increased risk of harms.

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment) and by imprecise results (limited study size for each comparison).

Summary

A Cochrane review included 2 studies with a total of 271 women and 542 infants. One trial was at an overall low risk of bias, and one trial was at unclear risk of selection bias, performance bias and detection bias. There were no statistically significant differences identified between a policy of elective birth at 37 weeks' gestation and expectant management with regards to birth by caesarean section (risk ratio (RR) 1.05; 95% confidence interval (CI) 0.83 to 1.32; 2 studies, n=271); perinatal death or serious perinatal morbidity (RR 0.34; 95% CI 0.01 to 8.35; 2 studies, n=542); or maternal death or serious maternal morbidity (RR 0.29; 95% CI 0.06 to 1.38; one study, n=235). There were no statistically significant differences identified for the pre-specified secondary maternal and infant review outcomes reported by these two trials between the two treatment policies (including for: haemorrhage requiring blood transfusion; instrumental vaginal birth; meconium-stained liquor; Apgar score less than seven at five minutes; admission to neonatal intensive care; birthweight less than 2500 g; neonatal encephalopathy; and respiratory distress syndrome).

Clinical comments

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Ədəbiyyat

1. Dodd JM, Deussen AR, Grivell RM et al. Elective birth at 37 weeks' gestation for women with an uncomplicated twin pregnancy. Cochrane Database Syst Rev 2014;(2):CD003582.