Background The optimal mode of delivery for twins is undetermined.Objective To review literature regarding the neonatal outcomes following twin delivery.Data sources Searches were conducted in PubMed, Medline, Embase, Cochrane library and reference lists.Selection criteria Studies selection criteria were: both twins alive at labour, outcomes stratified for birth order, presentation, planned and actual delivery mode. Eighteen articles were included in the meta-analysis (39 571 twin sets). Data collection and analysisThe Meta-analysis of Observational Studies in Epidemiology guidelines were followed. Interstudy heterogeneity (I 2 ) was tested. A fixed model was generated whenever I 2 < 25%. Pooled odds ratios (OR) with 95% CI were computed. Intergroup comparison was significant if 95% CI did not encompass 1. The first and second twins were indicated as Twin A (TA) and Twin B (TB), respectively.Main results Neonatal morbidity was lower in TA than TB (3.0 versus 4.6%; OR 0.53; 95% CI 0.39-0.70). TA experienced neonatal death less often than TB (0.3 versus 0.6%; OR 0.55; 95% CI 0.38-0.81). No differences were noted between vertex and non-vertex and attempted vaginal delivery versus planned caesarean section in either TA or TB. In TA, neonatal morbidity was lower after vaginal delivery (1.1%) than caesarean section (2.2%; OR 0.47; 95% CI 0.27-0.82). Neonatal death was not associated with actual delivery mode. In TB, morbidity following combined delivery (19.8%) was higher than after vaginal delivery (9.5%; OR 0.55; 95% CI 0.41-0.74) or caesarean section (9.8%; OR 0.47; 95% CI 0.43-0.53). When outcomes were stratified for both presentation and delivery mode, mortality rate was lower after vaginal delivery than caesarean section for both vertex and nonvertex TB.Author's conclusion An attempt at vaginal delivery should be considered in twin pregnancies with vertex/vertex presentation.
ObjectiveTo evaluate the outcomes of monochorionic diamniotic (MCDA) twins complicated by selective fetal growth restriction (sFGR) Type II who underwent laser photocoagulation and to validate the subclassification previously proposed by Chmait et al. (Type IIA with normal Doppler assessment of the ductus venosus (DV) and middle cerebral artery (MCA) of the growth‐restricted fetuses and Type IIB with DV absent or reversed flow during atrial contractions and/or MCA peak systolic velocity equal or greater than 1.5 Multiple of Median [MoM]) in a larger multicenter cohort.MethodsThis retrospective multicenter study included all MCDA twins complicated by Type II sFGR who underwent laser photocoagulation of placental anastomoses at four large tertiary fetal care centers between 2006 and 2020. Cases were then subclassified into Type IIA or IIB based of Doppler evaluation of fetal DV and MCA‐PSV as previously mentioned. Demographic characteristics and pregnancy outcomes were compared between groups. Data was presented as mean ± standard deviation or numbers and percentages as appropriate. P‐value ˃0.05 is considered statistically significant.ResultsA total of 98 patients with MCDA twins met our inclusion criteria, with 56 sub‐classified as Type IIA and 42 as Type IIB. Demographic characteristics were similar between the groups; however, Type IIB cases tended to have an earlier gestational age at diagnosis and at laser surgery as well as larger intertwin estimated fetal weight discordance, which may be a reflection of disease severity. Postnatal survival of the growth‐restricted fetus was significantly lower in Type IIB compared to Type IIA cases (23.8% vs 46.4%, P = 0.034)ConclusionsIn MCDA twins complicated by sFGR Type II and treated with laser photocoagulation of placental anastomoses, preoperative Doppler assessment of the ductus venosus and middle cerebral artery help to identify subset of patients at increased risk of demise of the growth‐restricted fetuses following intervention. Our study provides valuable information for guiding the surgical management options and patient counseling.This article is protected by copyright. All rights reserved.
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