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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
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논문 기본 정보

Type
Academic journal
Author
Ko Hyun Sun (가톨릭대학교) Choi Sae-kyung (가톨릭대학교) JeongHa Wie (가톨릭대학교) 박인양 (가톨릭대학교) PARK YONG GYU (가톨릭대학교) 신종철 (가톨릭대학교)
Journal
대한의학회 Journal of Korean Medical Science Journal of Korean Medical Science Vol.33 No.10 KCI Accredited Journals
Published
2018.1
Pages
43 - 51 (9page)

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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
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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.

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References (21)

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HeeYeonWoo / 2003 / Marker Chromosomes in Korean Patients: Incidence, Identification and Diagnostic Approach / Journal of Korean Medical Science 18(6):779~782 google schola Ortibus E / 2009 / The pregnancy and long-term neurodevelopmental outcome of monochorionic diamniotic twin gestations: a multicenter prospective cohort study from the first trimester onward / Am J Obstet Gynecol 200(5):494.e1~494.e8 Crossref Russo FM / 2013 / Stillbirths in singletons, dichorionic and monochorionic twins: a comparison of risks and causes / Eur J Obstet Gynecol Reprod Biol 170(1):131~136 Crossref Scher AI / 2002 / The risk of mortality or cerebral palsy in twins: a collaborative population-based study / Pediatr Res 52(5):671~681 Crossref Wenstrom KD / 1988 / Incidence, morbidity and mortality, and diagnosis of twin gestations / Clin Perinatol 15(1):1~11 Crossref

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