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.
- Author:
Hyun Sun KO
1
;
Sae Kyung CHOI
;
Jeong Ha WIE
;
In Yang PARK
;
Yong Gyu PARK
;
Jong Chul SHIN
Author Information
- Publication Type:Original Article
- Keywords: Stillbirth; Infant Death; Delivery, Obstetric; Pregnancy, Multiple
- MeSH: 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
- From:Journal of Korean Medical Science 2018;33(10):e80-
- CountryRepublic of Korea
- Language:English
- 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.
