Elective delivery of women with a twin pregnancy from 37 weeks' gestation

BACKGROUND: The optimal timing of birth for women with an otherwise uncomplicated twin pregnancy at term is uncertain, with clinical support for both elective delivery at 37 weeks, as well as expectant management (awaiting the spontaneous onset of labour). OBJECTIVES: To assess a policy of elective delivery from 37 weeks' gestation compared with an expectant approach for women with an otherwise uncomplicated twin pregnancy. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (29 July 2009). SELECTION CRITERIA: Randomised controlled trials with reported data which compared outcomes in mothers and babies who underwent elective delivery from 37 weeks' gestation in a twin pregnancy with outcomes in controls who were managed expectantly. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. Outcomes listed were collected from the identified trial. MAIN RESULTS: A single randomised controlled trial comparing elective induction of labour at 37 weeks for women with a twin pregnancy with expectant management was identified. A total of 36 women were recruited to the trial with 17 women allocated to the induction of labour group and 19 women to the expectant management group. For primary outcomes, there were no statistically significant differences between elective induction of labour and expectant management with regards to all caesarean births (risk ratio (RR) 0.56, 95% confidence interval (CI) 0.16 to 1.90), caesarean birth for fetal distress (RR 0.37, 95% CI 0.02 to 8.53), or perinatal death (RR not estimable). For secondary outcomes, there were no statistically significant differences between the two interventions with regards to haemorrhage requiring blood transfusion (RR 0.37, 95% CI 0.02 to 8.53), meconium-stained liquor (RR 0.10, 95% CI 0.01 to 1.77), Apgar score of less than seven at five minutes (RR not estimable), and infant birthweight less than 2500 grams (RR 0.95, 95% CI 0.49 to 1.82). AUTHORS' CONCLUSIONS: The small trial identified was underpowered to detect the outcome measures of interest. Consequently, there are insufficient data available to support a practice of elective delivery from 37 weeks' gestation for women with an otherwise uncomplicated twin pregnancy at term.