Elective birth at 37 weeks of gestation versus standard care for women with an uncomplicated twin pregnancy at term: the Twins Timing of Birth Randomised Trial
Elective birth at 37 weeks of gestation versus standard care for women with an uncomplicated twin pregnancy at term: the Twins Timing of Birth Randomised Trial
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DOI：
10.1111/j.1471-0528.2012.03356.x
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发表时间：
2012-07-01
影响因子：
5.8
通讯作者：
Robinson, J. S.
中科院分区：
文献类型：
--
作者：
Dodd, J. M.;Crowther, C. A.;Robinson, J. S.
目的评估在不增加危害的情况下，在妊娠37周选择分娩是否与双胎妊娠无并发症的妇女的死亡风险或严重结局有关。澳大利亚、新西兰和意大利的妇产科医院。共有235名怀孕36周+6周的无并发症双胞胎妊娠的妇女，没有继续怀孕的禁忌症。方法使用计算机生成的中央电话随机服务，235名妇女被随机分为选择性分娩(37周出生；n=116)或标准护理(继续期待治疗，计划从38周出生；n=119)。结果对于无并发症双胎妊娠的妇女来说，妊娠37周的选择性分娩与婴儿严重不良结局的风险显著降低(选择性分娩11/232[4.7%]与标准护理29/238[12.2%]；风险比[RR]0.39；95%可信区间0.200.75；P=0.005)，反映了使用单胎胎龄特定图表(选择性出生7/232[3.0%]对标准护理24/238[10.1%]；相对危险度0.30；95%可信区间0.130.67；P=0.004)。在使用双胎孕龄特定图表的事后分析中，有证据表明严重不良婴儿结局的主要组合有减少的趋势(择期分娩组4/232[1.7%]与标准护理组12/238[5.0%]；RR 0.34；95%CI 0.11至1.05；P=0.06)。结论我们的研究结果支持对妊娠37周的无并发症双胞胎妊娠的妇女的建议。
Objective To evaluate whether for women with an uncomplicated twin pregnancy, elective birth at 37 weeks of gestation was associated with reduced risk of death or serious outcomes for babies, without increasing harm.Design Randomised controlled trial. Setting Maternity hospitals across Australia, New Zealand and Italy.Population A total of 235 women with an uncomplicated twin pregnancy at 36+6 weeks of gestation, with no contraindication to continuing their pregnancy.Methods Using a computer-generated, central telephone randomisation service, 235 women were randomised to Elective Birth (birth at 37 weeks; n = 116) or Standard Care (continued expectant management, with birth planned from 38 weeks; n = 119). Outcome assessors were masked to treatment allocation.Main outcome measure A composite of serious adverse outcome for the infant.Results For women with an uncomplicated twin pregnancy, elective birth at 37 weeks of gestation was associated with a significant reduction in risk of serious adverse outcome for the infant (Elective Birth 11/232 [4.7%] versus Standard Care 29/238 [12.2%]; risk ratio [RR] 0.39; 95% CI 0.200.75; P = 0.005), reflecting a reduction in birthweight less than the third centile using singleton gestational age-specific charts (Elective Birth 7/232 [3.0%] versus Standard Care 24/238 [10.1%]; RR 0.30; 95% CI 0.130.67; P = 0.004). In a post hoc analysis using twin gestational age-specific charts, there was evidence of a trend towards a reduction in the primary composite of serious adverse infant outcome (Elective Birth Group 4/232 [1.7%] versus Standard Care Group 12/238 [5.0%]; RR 0.34; 95% CI 0.11 to 1.05; P = 0.06).Conclusion The findings of our study support recommendations for women with an uncomplicated twin pregnancy to birth at 37 weeks of gestation.