OBJECTIVE
This meta-analysis aimed to evaluate the success rate of trial of labor in monochorionic
diamniotic pregnancies and the impact of delivery mode on neonatal outcomes.
DATA SOURCES
Searches were performed in MEDLINE/PubMed, Embase, Scopus, Cochrane Central Register
of Controlled Trials, ClinicalTrials.gov, and the International Clinical Trials Registry
Platform from the inception of each database until April 2022.
STUDY ELIGIBILITY CRITERIA
Selection criteria included observational studies analyzing the delivery mode among
monochorionic diamniotic gestations.
METHODS
All analyses were carried out using an intention-to-treat approach, evaluating women
according to the delivery mode to which they were assigned in the original studies.
RESULTS
Seventeen studies met the eligibility criteria and were suitable for qualitative and
quantitative analysis. In total, 4116 women were analyzed. This meta-analysis showed
that trial of labor in monochorionic diamniotic pregnancies resulted in vaginal delivery
of both twins in 75.5% of cases (95% confidence interval, 69.1–80.9). Failure to deliver
the second twin vaginally occurred in 3.8% of cases (95% confidence interval, 2.5–5.7).
In addition, the neonatal outcomes were comparable among women with monochorionic
diamniotic pregnancy undergoing different planned delivery modes. Neonatal death occurred
in 3.7 per 1000 cases in the planned cesarean delivery group and in 1.6 per 1000 cases
in the planned vaginal delivery group. Perinatal death was observed in 7.5 per 1000
cases in the planned cesarean delivery group and in 5.8 per 1000 cases in the planned
vaginal delivery group. Umbilical artery pH <7.00 occurred in 0 per 1000 cases in
the planned cesarean delivery and 4.6 per 1000 cases in the planned vaginal delivery
group. Neonatal intensive care unit stay of >72 hours had a prevalence of 59.7 per
1000 cases in the planned cesarean delivery and 42.8 per 1000 cases in the planned
vaginal delivery group.
CONCLUSION
This meta-analysis showed that trial of labor in monochorionic diamniotic pregnancies
is successful in most cases and relatively safe, considering that neonatal and perinatal
mortality and severe morbidity were comparable between the trial of labor and planned
cesarean delivery groups. Therefore, the choice of planned delivery mode in twin gestations
should not be made a priori.
Key words
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Article info
Publication history
Published online: October 08, 2022
Accepted:
October 3,
2022
Received:
September 23,
2022
Footnotes
The authors report no conflict of interest.
No financial support was received for this study.
This study was registered on the International Prospective Register of Systematic Reviews (date and registration: May 10, 2022; CRD42022324573).
This meta-analysis is exempt from ethical approval because it only involved anonymous data that had already been published.
All data were extracted from previously published studies, thus they are publicly available.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
