Outcomes of twin pregnancies complicated by prelabor rupture of membranes before 26 weeks of gestation: systematic review and meta-analysis
Notice bibliographique
Résumé
OBJECTIVE: To investigate the rate of obstetric and perinatal outcomes of premature rupture of membranes (PROM) occurring before 26 weeks in twin pregnancies. DATA SOURCE: Medline, Embase, Cinahl and Web of Science databases were searched electronically up to January 2024. STUDY ELIGIBILITY CRITERIA: The selection criteria included both prospective and retrospective studies of twin pregnancies with PROM before 26 weeks of gestation. Case reports, case series with fewer than 5 cases, review articles, letters to the editor and editorials were excluded. Studies including both singletons and twin pregnancies were also excluded. STUDY APPRAISAL AND SYNTHESIS METHOD: We used meta-analyses of proportions to combine data and assess the pooled proportions. We used a random-effect model to perform the pooled data analyses. The study was registered with the PROSPERO database (CRD 42022368057). Quality assessment of the included studies was performed usingthe Newcastle-Ottawa Scale for cohort studies. RESULTS: Eight studies including 227 twin pregnancies were included in the analysis. The pooled proportion of termination of pregnancy (TOP) was 4.6 % (95 % CI 1.5-13.4), while the rate of selective TOP (sTOP) was 24.5 % (95 % CI 7.1-57.7). After the exclusion of cases of TOP, the overall rate of spontaneous miscarriage or fetal demise was 20.9 % (95 % CI 11.1-35.8), whereas the live birth rate of at least one twin was 71.6 % (95 % CI 61.2-80.1) of the ongoing pregnancies. The mean gestational age at delivery was 26.5 (95 % CI 25.1-28.0) weeks and the mean latency between PROM and delivery was 5.4 weeks (95 % CI 4.8-5.9) in all cases including those with fetal deaths. Neonatal outcomes showed that the overall neonatal mortality was 26.4 % (95 % CI 16.7-39.2). When focusing only on pregnancies undergoing sTOP, the observed livebirth rate was 87.7 %. The gestational age at rupture of membranes in these cases was 16.8 (95 % CI 14.9-18.6) weeks and the latency between PROM and delivery was significantly longer (19.9 (95 % CI 18.0-21.7) weeks) than that observed in unterminated pregnancies, with a mean gestational age at delivery nearly in the range of term (36.9 weeks). CONCLUSIONS: PROM in twins before 26 weeks is associated with overall high rates of adverse obstetric and neonatal outcomes, and it represents a clinical challenge for both counseling and management. Larger prospective studies unified objective protocols in terms of antenatal surveillance and management are needed.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,007 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,010 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».