J Korean Med Sci.  2018 Mar;33(10):e80. 10.3346/jkms.2018.33.e80.

Optimal Timing of Delivery Based on the Risk of Stillbirth and Infant Death Associated with Each Additional Week of Expectant Management in Multiple Pregnancies: a National Cohort Study of Koreans

Affiliations
  • 1Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea. ooooobbbbb@catholic.ac.kr
  • 2Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Abstract

BACKGROUND
The purpose of this study was to compare the fetal/infant mortality risk associated with each additional week of expectant management to that associated with immediate delivery in women with multiple gestations.
METHODS
This was a retrospective national cohort study of 94,170 multiple deliveries, 92,619 (98.4%) twin and 1,352 (1.44%) triplet pregnancies, between 32 0/7 and 42 6/7 weeks of gestation recorded in the Korean vital statistics database. We investigated the risks of stillbirth and infant death after birth in Korea according to the week of gestation in twin and triplet pregnancies.
RESULTS
The risk of stillbirth significantly increased between 34 and 35 weeks of gestation and between 37 and 38 weeks of gestation in twin pregnancies and between 34 and 37 weeks of gestation in triplet pregnancies. The risk of infant death following delivery gradually decreased as pregnancies approached full term. Week-by-week differences were statistically significant between 33 and 34 weeks, with decreasing risks of infant death at advancing gestational ages in twin pregnancies. At 37 weeks of gestation, the relative risk of mortality was significantly higher with expectant management compared with immediate delivery (relative risk, 3.00; 95% confidence interval, 1.41-6.38).
CONCLUSION
In twin pregnancies, delivery at 37 weeks of gestation can minimize the risks of stillbirth and infant death in uncomplicated cases, although individual maternal and fetal characteristics must be considered when determining the optimal timing of delivery. In multiple pregnancies, close fetal surveillance is needed after 34 weeks of gestation.

Keyword

Stillbirth; Infant Death; Delivery, Obstetric; Pregnancy, Multiple

MeSH Terms

Cohort Studies*
Delivery, Obstetric
Female
Gestational Age
Humans
Infant Death*
Infant*
Korea
Mortality
Parturition
Pregnancy
Pregnancy, Multiple*
Pregnancy, Triplet
Pregnancy, Twin
Retrospective Studies
Stillbirth*
Twins
Vital Statistics
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