Perinatal mortality, timing of delivery and prenatal management of monoamniotic twin pregnancy: systematic review and meta‐analysis

D’Antonio, F.; Odibo, Anthony O.; Berghella, Vincenzo; Khalil, Asma; Hack, K.E.A.; Saccone, Gabriele; Prefumo, Federico; Buca, D.; Liberati, Marco; Pagani, G.; Acharya, Ganesh

doi:10.1002/uog.20100

Cited by 61 publications

(67 citation statements)

References 39 publications

(61 reference statements)

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“…To date, SET policy has become the central strategy in many IVF centers, as it has ability to reduce the rate of multiple pregnancies which are known to be associated with adverse maternal and neonatal outcomes . In this meta‐analysis, we observed that day 6 BET are associated with lower pregnancy outcomes than day 5 BET following SET cycle, while transferring more than two day 5 blastocysts is associated with similar pregnancy outcomes compared with transferring same number of day 6 blastocysts.…”

Section: Discussionmentioning

confidence: 69%

Pregnancy outcomes after day 5 versus day 6 blastocyst‐stage embryo transfer: A systematic review and meta‐analysis

Wang²,

Sun

et al. 2020

J of Obstet and Gynaecol

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Aim To compare the pregnancy outcomes after day 5 blastocyst‐stage embryo transfers (BET) versus day 6 BET following vitrified‐warmed cycle and to evaluate whether the number of embryos transferred and the chromosomal status of embryo influence effect estimates. Methods A literature search (PubMed, Embase and MEDLINE) up to January 2019 was conducted to identify studies where women with day 6 BET were compared to women with day 5 BET. Only studies published in English language, on peer‐reviewed journal were considered eligible. The following subgroup analyses were performed: (i) number of embryos transferred and (ii) chromosomal status of embryo. Results From a total of 1956 articles identified, 23 observational studies were included in the meta‐analysis. We observed that day 6 BET were associated with lower implantation rate (risk ratio, RR: 1.17, 95% confidence interval, CI: 1.10–1.24), clinical pregnancy rate (RR: 1.17, 95% CI: 1.10–1.24), ongoing pregnancy rate (RR: 1.15, 95% CI: 1.07–1.24) and live birth rate (RR: 1.22, 95% CI: 1.11–1.33) than day 5 BET following vitrified‐warmed cycle. The subgroup analysis found that the superiority of day 5 BET compared with day 6 BET is influenced by the number of embryos transferred and chromosomal status of embryos. Conclusion Current evidence shows that day 5 BET is superior to day 6 BET following vitrified‐warmed cycle in clinical practice. Due to the overall low quality of available evidence, more larger and well‐conducted studies are needed to compare the pregnancy outcomes between day 5 and day 6 BET before drawing a clear conclusion.

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Section: Discussionmentioning

confidence: 69%

Pregnancy outcomes after day 5 versus day 6 blastocyst‐stage embryo transfer: A systematic review and meta‐analysis

Wang²,

Sun

et al. 2020

J of Obstet and Gynaecol

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“…There are no randomized controlled trials comparing the different management protocols in MCMA twin pregnancies. There is also wide variation in practice with regard to the type and frequency of fetal monitoring and timing of initiation of fetal surveillance among recently published studies. Fortnightly ultrasound assessment and prompt referral of cases affected by TTTS to centers with high expertise in fetal surgery have led to a significant reduction in the rate of perinatal mortality in MCDA twin pregnancies.…”

Section: Discussionmentioning

confidence: 99%

“…The overall incidence of fetal loss in MCMA twin pregnancies is approximately 6%, the large majority of which occur before 30 weeks' gestation. TTTS can also occur in MCMA twin pregnancies, although its incidence has been reported to be 2.4 to 2.7 times lower than in MCDA twin gestations. The lower incidence of TTTS in MCMA pregnancies probably reflects the different anastomotic pattern observed in monoamniotic gestations, in which there is a higher prevalence of arterioarterial anastomoses, which are protective against the occurrence of this pathology.…”

Section: Introductionmentioning

confidence: 99%

“…Monochorionic monoamniotic (MCMA) twin pregnancies are at a higher risk of perinatal mortality and morbidity than are MCDA gestations. The overall incidence of fetal loss in MCMA twin pregnancies is approximately 6%, the large majority of which occur before 30 weeks' gestation. TTTS can also occur in MCMA twin pregnancies, although its incidence has been reported to be 2.4 to 2.7 times lower than in MCDA twin gestations.…”

Section: Introductionmentioning

confidence: 99%

“…Twin‐to‐twin transfusion syndrome (TTTS) is one of the most severe complications of monochorionic twin pregnancy, with an estimated incidence of 9–15%. Although the pathophysiology of TTTS has not yet been fully elucidated, the anatomical prerequisite for its occurrence is the presence of intertwin vascular anastomoses within the placenta, which are present in virtually every monochorionic gestation. TTTS is associated with a high risk of perinatal mortality and morbidity if not treated.…”

Section: Introductionmentioning

confidence: 99%

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Outcome of twin‐to‐twin transfusion syndrome in monochorionic monoamniotic twin pregnancy: systematic review and meta‐analysis

Murgano

Khalil

Prefumo³

et al. 2020

Ultrasound in Obstet & Gyne

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Objectives To explore the outcome of monochorionic monoamniotic (MCMA) twin pregnancies affected by twin‐to‐twin transfusion syndrome (TTTS). Methods MEDLINE and EMBASE databases were searched for studies reporting the outcome of MCMA twin pregnancies complicated by TTTS. The primary outcome was intrauterine death (IUD); secondary outcomes were miscarriage, single IUD, double IUD, neonatal death (NND), perinatal death (PND), survival of at least one twin, survival of both twins and preterm birth (PTB) before 32 weeks' gestation. Outcomes were assessed in MCMA twins affected by TTTS not undergoing intervention and in those treated with amniodrainage, laser therapy or cord occlusion. Subgroup analysis was performed including cases diagnosed before 24 weeks. Random‐effects meta‐analysis of proportions was used to analyze the data. Results Fifteen cohort studies, including 888 MCMA twin pregnancies, of which 44 were affected by TTTS, were included in the review. There was no randomized trial comparing the different management options in MCMA twin pregnancies complicated by TTTS. In cases not undergoing intervention, miscarriage occurred in 11.0% of fetuses, while the incidence of IUD, NND and PND was 25.2%, 12.2% and 31.2%, respectively. PTB complicated 50.5% of these pregnancies. In cases treated by laser surgery, the incidence of miscarriage, IUD, NND and PND was 19.6%, 27.4%, 7.4% and 35.9%, respectively, and the incidence of PTB before 32 weeks' gestation was 64.9%. In cases treated with amniodrainage, the incidence of IUD, NND and PND was 31.3%, 13.5% and 45.7% respectively, and PTB complicated 76.2% of these pregnancies. Analysis of cases undergoing cord occlusion was affected by the very small number of included cases. Miscarriage occurred in 19.2%, while there was no case of IUD or NND of the surviving twin. PTB before 32 weeks occurred in 50.0% of these cases. Conclusions MCMA twin pregnancies complicated by TTTS are at high risk of perinatal mortality and PTB. Further studies are needed in order to elucidate the optimal type of prenatal treatment in these pregnancies. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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Monochorionic monoamniotic twin pregnancy: Inpatient or outpatient management? Our experience

Vasciaveo

Zanzarelli

Lucia

et al. 2023

J of Clinical Ultrasound

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Perinatal mortality, timing of delivery and prenatal management of monoamniotic twin pregnancy: systematic review and meta‐analysis

Cited by 61 publications

References 39 publications

Pregnancy outcomes after day 5 versus day 6 blastocyst‐stage embryo transfer: A systematic review and meta‐analysis

Pregnancy outcomes after day 5 versus day 6 blastocyst‐stage embryo transfer: A systematic review and meta‐analysis

Outcome of twin‐to‐twin transfusion syndrome in monochorionic monoamniotic twin pregnancy: systematic review and meta‐analysis

Monochorionic monoamniotic twin pregnancy: Inpatient or outpatient management? Our experience

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