Evidence map›Paper›PMID 27599496›Full record

SynthesisBMJ (Clinical research ed.)2016

Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis.

Fiona Cheong-See, Ewoud Schuit, David Arroyo-Manzano, Asma Khalil, Jon Barrett, K S Joseph, Elizabeth Asztalos, Karien Hack, Liesbeth Lewi, Arianne Lim and 27 more

Registry-linked trialAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ (Clinical research ed.), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05104255 (Factors Influencing the Neonatal Outcomes in Twin Pregnancies Undergoing Cesarean Section), which is not on this map. Cited by 99 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
99citing papers in PubMed, 9 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05104255 completednot on this mapstarted 2017, after this paper: background citation

Factors Influencing the Neonatal Outcomes in Twin Pregnancies Undergoing Cesarean Section: a Cross-sectional Study

TypeobservationalSponsorDerince Training and Research HospitalRan2017 to 2020Enrolled527ConditionsTwin Pregnancy, NeonateArmsSpinal anesthesia, General anesthesia
3 · Its place in the literature

Who cites it

99 citing papers in PubMed, 9 syntheses or guidelines pooled it.

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  11. Planned Cesarean or planned vaginal delivery for twins: secondary analysis of randomized controlled trial.Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology · 2021
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  20. Adverse perinatal outcomes in twins: comparison of intertwin fetal size discordance vs singleton and twin fetal growth charts.Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology · 2026
    Article

39 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

37 authors.

Fiona Cheong-SeeWomen's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London E1 2AB, UK.
Ewoud SchuitJulius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, Netherlands Stanford Prevention Research Center, Stanford University, Palo Alto, Stanford, CA 94305, USA.
David Arroyo-ManzanoClinical Biostatistics Unit, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.
Asma KhalilFetal Medicine Unit, St George's Healthcare NHS Trust, London SW17 0QT, UK.
Jon BarrettEvaluative Clinical Sciences, Women and Babies Research Program, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada.
K S JosephDepartment of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC V6Z 2K5, Canada.
Elizabeth AsztalosDepartment of Newborn and Developmental Paediatrics, Women and Babies Research Program, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada.
Karien HackDepartment of Gynaecology and Obstetrics, Diakonessenhuis, 3582 KE Utrecht, Netherlands.
Liesbeth LewiDepartment of Obstetrics-Gynaecology, University Hospitals, 3000 Leuven, Belgium Department of Development and Regeneration: Pregnancy, Fetus and Neonate, KU Leuven, Belgium.
Arianne LimDepartment of Obstetrics and Gynaecology, Academic Medical Centre, 1105 AZ Amsterdam, Netherlands.
Sophie LiemDepartment of Obstetrics and Gynaecology, Academic Medical Centre, 1105 AZ Amsterdam, Netherlands.
Jane E NormanUniversity of Edinburgh MRC Centre for Reproductive Health, Queen's Medical Research Institute, Edinburgh EH16 4TY, UK.
John MorrisonDepartment of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, MS, USA.
C Andrew CombsObstetrix Collaborative Research Network, Center for Research, Education and Quality, Mednax National Medical Group, FL 33323, USA.
Thomas J GariteObstetrix Collaborative Research Network, Center for Research, Education and Quality, Mednax National Medical Group, FL 33323, USA University of California Irvine, Irvine, CA 92697, USA.
Kimberly MaurelObstetrix Collaborative Research Network, Center for Research, Education and Quality, Mednax National Medical Group, FL 33323, USA.
Vicente SerraMaternal-Fetal Medicine Unit, Instituto Valenciano de Infertilidad, University of Valencia, Spain Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Valencia, Jefe Servicio Obstetricia Hospital U P La FE, Torre F, Valencia, Espana.
Alfredo PeralesDepartment of Obstetrics and Gynaecology, Faculty of Medicine, University of Valencia, Jefe Servicio Obstetricia Hospital U P La FE, Torre F, Valencia, Espana Department of Obstetrics, University Hospital La Fe, Valencia, 46026 València, Spain.
Line RodeCentre of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Katharina WordaDepartment of Obstetrics and Gynaecology, Medical University of Vienna, 1090 Wien, Austria.
Anwar NassarDepartment of Obstetrics and Gynaecology, American University of Beirut Medical Centre, Riad El Solh, Beirut 1107 2020, Lebanon.
Mona AboulgharThe Egyptian IVF Centre, Maadi and Department of Obstetrics and Gynaecology, Faculty of Medicine, Cairo University, Oula, Giza, Egypt.
Dwight RouseDepartment of Obstetrics and Gynecology, Women and Infants Hospital, Brown University Women and Infants Hospital, Providence, RI 02905, USA.
Elizabeth ThomRoyal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Republic of Ireland.
Fionnuala BreathnachRoyal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Republic of Ireland.
Soichiro NakayamaDepartment of Maternal Fetal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka 594-1101, Japan.
Francesca Maria RussoDepartment of Obstetrics and Gynecology, University of Milano-Bicocca, 20126 Milan, Italy.
Julian N RobinsonDivision of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Jodie M DoddRobinson Research Institute, and Discipline of Obstetrics and Gynaecology, University of Adelaide, North Adelaide SA 5006, Australia.
Roger B NewmanDepartment of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC 29403, USA.
Sohinee BhattacharyaUniversity of Aberdeen, Dugald Baird Centre for Research on Women's Health, Aberdeen Maternity Hospital, Aberdeen AB25 2ZL, UK.
Selphee TangDepartment of Obstetrics and Gynecology, Alberta Health Services, Calgary, AB T2N 2T9, Canada.
Ben Willem J MolAustralian Research Centre for Health of Women and Babies, Robinson Institute, University of Adelaide, North Adelaide, SA 5006, Australia.
Javier ZamoraClinical Biostatistics Unit, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain javier.zamora@hrc.es.
Basky ThilaganathanFetal Medicine Unit, St George's Healthcare NHS Trust, London SW17 0QT, UK.
Shakila ThangaratinamWomen's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London E1 2AB, UK.
Global Obstetrics Network (GONet) Collaboration

Funding

Data Coord Ctr-NICHD Cooperative Multicenter Maternal Medicine Units Research NetU10HD036801 · NICHD · GEORGE WASHINGTON UNIVERSITY · PI CLIFTON, REBECCA GERSNOVIEZ · 2009 to 2021
$174.2M
NICHD NIH HHS U10 HD036801
6 · The paper itself

Abstract

objectiveTo determine the risks of stillbirth and neonatal complications by gestational age in uncomplicated monochorionic and dichorionic twin pregnancies.

designSystematic review and meta-analysis. DATA SOURCES: Medline, Embase, and Cochrane databases (until December 2015). REVIEW

methodsDatabases were searched without language restrictions for studies of women with uncomplicated twin pregnancies that reported rates of stillbirth and neonatal outcomes at various gestational ages. Pregnancies with unclear chorionicity, monoamnionicity, and twin to twin transfusion syndrome were excluded. Meta-analyses of observational studies and cohorts nested within randomised studies were undertaken. Prospective risk of stillbirth was computed for each study at a given week of gestation and compared with the risk of neonatal death among deliveries in the same week. Gestational age specific differences in risk were estimated for stillbirths and neonatal deaths in monochorionic and dichorionic twin pregnancies after 34 weeks' gestation.

results32 studies (29 685 dichorionic, 5486 monochorionic pregnancies) were included. In dichorionic twin pregnancies beyond 34 weeks (15 studies, 17 830 pregnancies), the prospective weekly risk of stillbirths from expectant management and the risk of neonatal death from delivery were balanced at 37 weeks' gestation (risk difference 1.2/1000, 95% confidence interval -1.3 to 3.6; I(2)=0%). Delay in delivery by a week (to 38 weeks) led to an additional 8.8 perinatal deaths per 1000 pregnancies (95% confidence interval 3.6 to 14.0/1000; I(2)=0%) compared with the previous week. In monochorionic pregnancies beyond 34 weeks (13 studies, 2149 pregnancies), there was a trend towards an increase in stillbirths compared with neonatal deaths after 36 weeks, with an additional 2.5 per 1000 perinatal deaths, which was not significant (-12.4 to 17.4/1000; I(2)=0%). The rates of neonatal morbidity showed a consistent reduction with increasing gestational age in monochorionic and dichorionic pregnancies, and admission to the neonatal intensive care unit was the commonest neonatal complication. The actual risk of stillbirth near term might be higher than reported estimates because of the policy of planned delivery in twin pregnancies.

conclusionsTo minimise perinatal deaths, in uncomplicated dichorionic twin pregnancies delivery should be considered at 37 weeks' gestation; in monochorionic pregnancies delivery should be considered at 36 weeks. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42014007538.

Indexed as

FemaleGestational AgeHumansInfant, NewbornInfant, Newborn, DiseasesIntensive Care, NeonatalPerinatal DeathPregnancyPregnancy, TwinProspective StudiesRisk FactorsStillbirthTwins, DizygoticTwins, Monozygotic

Identifiers

PMID27599496
PMCPMC5013231

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.