Advertisement

What is the success rate of trial of labor in monochorionic diamniotic twins? A systematic review and meta-analysis of observational studies

Published:October 08, 2022DOI:https://doi.org/10.1016/j.ajogmf.2022.100767

      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology MFM
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sau A
        • Chalmers S
        • Shennan AH
        • Fox G
        • Maxwell D.
        Vaginal delivery can be considered in monochorionic diamniotic twins.
        BJOG. 2006; 113: 602-604
        • Yamashita A
        • Ishii K
        • Taguchi T
        • et al.
        Adverse perinatal outcomes related to the delivery mode in women with monochorionic diamniotic twin pregnancies.
        J Perinat Med. 2014; 42: 769-775
        • Hoffmann E
        • Oldenburg A
        • Rode L
        • Tabor A
        • Rasmussen S
        • Skibsted L.
        Twin births: cesarean section or vaginal delivery?.
        Acta Obstet Gynecol Scand. 2012; 91: 463-469
        • Smith GCS
        • Fleming KM
        • White IR.
        Birth order of twins and risk of perinatal death related to delivery in England, Northern Ireland, and Wales, 1994-2003: retrospective cohort study.
        BMJ. 2007; 334: 576
        • Smith GCS
        • Shah I
        • White IR
        • Pell JP
        • Dobbie R.
        Mode of delivery and the risk of delivery-related perinatal death among twins at term: a retrospective cohort study of 8073 births.
        BJOG. 2005; 112: 1139-1144
        • Aviram A
        • Lipworth H
        • Asztalos EV
        • et al.
        Delivery of monochorionic twins: lessons learned from the Twin Birth Study.
        Am J Obstet Gynecol. 2020; 223 (e1–9): 916
        • Lopriore E
        • Holtkamp N
        • Sueters M
        • Middeldorp JM
        • Walther FJ
        • Oepkes D.
        Acute peripartum twin-twin transfusion syndrome: incidence, risk factors, placental characteristics and neonatal outcome.
        J Obstet Gynaecol Res. 2014; 40: 18-24
        • Verbeek L
        • Slaghekke F
        • Sueters M
        • et al.
        Hematological disorders at birth in complicated monochorionic twins.
        Expert Rev Hematol. 2017; 10: 525-532
        • Barrett JFR
        • Hannah ME
        • Hutton EK
        • et al.
        A randomized trial of planned cesarean or vaginal delivery for twin pregnancy.
        N Engl J Med. 2013; 369: 1295-1305
        • Lesser HN
        • Rebarber A
        • Fox NS.
        Mode of delivery in monochorionic compared with dichorionic twin pregnancies.
        Obstet Gynecol. 2021; 138: 348-352
        • Roberts CL
        • Algert CS
        • Nippita TA
        • Bowen JR
        • Shand AW.
        Association of prelabor cesarean delivery with reduced mortality in twins born near term.
        Obstet Gynecol. 2015; 125: 103-110
        • Page MJ
        • McKenzie JE
        • Bossuyt PM
        • et al.
        The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.
        PLoS Med. 2021; 18e1003583
        • Sterne JA
        • Hernán MA
        • Reeves BC
        • et al.
        Robins-I: a tool for assessing risk of bias in non-randomised studies of interventions.
        BMJ. 2016; 355: i4919
        • R Core Team
        R: A language and environment for statistical computing.
        R Foundation for Statistical Computing, Vienna, Republic of Austria2022
        • Borenstein M
        Introduction to meta-analysis.
        (editor) John Wiley & Sons, Chichester, United Kingdom of Great Britain and Northern Ireland2009
        • Schwarzer G
        • Chemaitelly H
        • Abu-Raddad LJ
        • Rücker G.
        Seriously misleading results using inverse of Freeman-Tukey double arcsine transformation in meta-analysis of single proportions.
        Res Synth Methods. 2019; 10: 476-483
        • Egger M
        • Davey Smith G
        • Schneider M
        • Minder C
        Bias in meta-analysis detected by a simple, graphical test.
        BMJ. 1997; 315: 629-634
        • Harbord RM
        • Egger M
        • Sterne JAC.
        A modified test for small-study effects in meta-analyses of controlled trials with binary endpoints.
        Stat Med. 2006; 25: 3443-3457
        • Sterne JAC
        • Sutton AJ
        • Ioannidis JPA
        • et al.
        Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials.
        BMJ. 2011; 343: d4002
        • Higgins JPT
        • Thompson SG
        • Deeks JJ
        • Altman DG.
        Measuring inconsistency in meta-analyses.
        BMJ. 2003; 327: 557-560
        • Borenstein M
        • Hedges LV
        • Higgins JPT
        • Rothstein HR.
        A basic introduction to fixed-effect and random-effects models for meta-analysis.
        Res Synth Methods. 2010; 1: 97-111
        • Chimenea A
        • García-Díaz L
        • Antiñolo G.
        Mode of delivery, perinatal outcome and neurodevelopment in uncomplicated monochorionic diamniotic twins: a single-center retrospective cohort study.
        BMC Pregnancy Childbirth. 2022; 22: 89
        • Wandel L
        • Abele H
        • Pauluschke-Fröhlich J
        • Kagan KO
        • Brucker S
        • Rall K.
        Mode of birth in monochorionic versus dichorionic twin pregnancies: a retrospective study from a large tertiary centre in Germany.
        BMC Pregnancy Childbirth. 2022; 22: 214
        • Rissanen AS
        • Gissler M
        • Nupponen IK
        • Nuutila ME
        • Jernman RM.
        Perinatal outcome of dichorionic and monochorionic-diamniotic Finnish twins: a historical cohort study.
        Acta Obstet Gynecol Scand. 2022; 101: 153-162
        • Krispin E
        • Zlatkin R
        • Weisz B
        • Mazaki-Tovi S
        • Yinon Y.
        Labor induction in twin pregnancies: does the perinatal outcome differ according to chorionicity?.
        Arch Gynecol Obstet. 2022; 306: 93-100
        • Schmitz T
        • Korb D
        • Azria E
        • et al.
        Perinatal outcome after planned vaginal delivery in monochorionic compared with dichorionic twin pregnancy.
        Ultrasound Obstet Gynecol. 2021; 57: 592-599
        • Dathan-Stumpf A
        • Winkel K
        • Stepan H.
        Delivery of twin gestation (≥ 32.0 weeks): the vaginal route as a practicable and safe alternative to Cesarean section.
        Geburtshilfe Frauenheilkd. 2020; 80: 1033-1040
        • Ylilehto E
        • Palomäki O
        • Huhtala H
        • Uotila J.
        Term twin birth - impact of mode of delivery on outcome.
        Acta Obstet Gynecol Scand. 2017; 96: 589-596
        • Garabedian C
        • Poulain C
        • Duhamel A
        • Subtil D
        • Houfflin-Debarge V
        • Deruelle P.
        Intrapartum management of twin pregnancies: are uncomplicated monochorionic pregnancies more at risk of complications than dichorionic pregnancies?.
        Acta Obstet Gynecol Scand. 2015; 94: 301-307
        • Pestana I
        • Loureiro T
        • Almeida A
        • Rocha I
        • Rodrigues RM
        • Rodrigues T.
        Effect of mode of delivery on neonatal outcome of monochorionic diamniotic twin pregnancies: a retrospective cohort study.
        J Reprod Med. 2013; 58: 15-18
        • Weisz B
        • Hogen L
        • Yinon Y
        • et al.
        Mode of delivery and neonatal outcome in uncomplicated monochorionic twin pregnancies.
        J Matern Fetal Neonatal Med. 2012; 25: 2721-2724
        • Breathnach FM
        • McAuliffe FM
        • Geary M
        • et al.
        Optimum timing for planned delivery of uncomplicated monochorionic and dichorionic twin pregnancies.
        Obstet Gynecol. 2012; 119: 50-59
        • Hack KEA
        • Derks JB
        • Elias SG
        • et al.
        Perinatal mortality and mode of delivery in monochorionic diamniotic twin pregnancies ≥ 32 weeks of gestation: a multicentre retrospective cohort study.
        BJOG. 2011; 118: 1090-1097
        • Leduc L
        • Takser L
        • Rinfret D.
        Persistance of adverse obstetric and neonatal outcomes in monochorionic twins after exclusion of disorders unique to monochorionic placentation.
        Am J Obstet Gynecol. 2005; 193: 1670-1675
        • Skupski DW
        • Sylvestre G
        • Di Renzo GC
        • Grunebaum A.
        Acute twin-twin transfusion syndrome in labor: pathophysiology and associated factors.
        J Matern Fetal Neonatal Med. 2012; 25: 456-460
        • Yang Q
        • Wen SW
        • Chen Y
        • Krewski D
        • Fung Kee Fung K
        • Walker M.
        Neonatal death and morbidity in vertex-nonvertex second twins according to mode of delivery and birth weight.
        Am J Obstet Gynecol. 2005; 192: 840-847