Delayed-interval delivery can save the second twin: evidence from a systematic review
1Department of Obstetrics and Gynaecology, Antwerp University Hospital (UZA), Edegem, Belgium.
Facts, Views & Vision in Obgyn
|February 18, 2017
Summary
Delayed interval delivery significantly improves survival for the second twin in preterm twin births. This benefit is observed even when the first twin is delivered at or after 24 weeks gestational age.
Area of Science:
- Perinatology
- Maternal-Fetal Medicine
- Neonatology
Background:
- The survival benefit of delayed interval delivery for the second twin in preterm births remains unclear.
- Preterm birth in twins presents unique challenges for neonatal outcomes.
Purpose of the Study:
- To systematically review the survival benefit of delayed interval delivery for the second twin compared to the first.
- To assess the survival benefit when delayed interval delivery is performed at or after 24 weeks gestational age.
Main Methods:
- Systematic review adhering to PRISMA guidelines.
- Inclusion of controlled and observational studies with at least 3 cases of delayed interval delivery in dichorionic diamniotic twin pregnancies.
- Meta-analysis of mortality risk using a random-effects model, with narrative synthesis for secondary outcomes.
Main Results:
- The second-born twin demonstrated a significantly lower mortality risk (RR=0.44) compared to the first-born twin.
- When the first delivery occurred at or after 24 weeks gestational age, the second-born twin also showed a significantly lower mortality risk (RR=0.37).
- Statistical heterogeneity was low (I²=0%) in both analyses.
Conclusions:
- Delayed interval delivery can improve the survival of the second twin in carefully selected preterm twin pregnancies.
- Management protocols vary, making a uniform strategy challenging.
- Informed consent is crucial, discussing potential benefits, risks of severe sequels, and maternal complications.
More Related Videos
Related Concept Videos
01:21Intrauterine Drug Delivery Systems
69
Controlled-release systems for intravaginal and intrauterine drug delivery have been developed primarily for the administration of contraceptive steroid hormones. These delivery routes circumvent first-pass hepatic metabolism, thereby enhancing bioavailability and allowing for reduced systemic dosages compared to oral administration. Such approaches contribute to improved therapeutic efficacy and patient compliance, particularly in long-term contraceptive regimens.Intravaginal Drug Delivery...
69
01:24Drug Accumulation During Multiple Dosing: Intermittent IV Infusions
319
Intermittent intravenous (IV) infusion is a method of drug administration where medications are delivered over short infusion periods followed by intervals of no drug delivery. This approach helps to prevent sustained high drug concentrations in the bloodstream, reducing the risk of adverse effects associated with prolonged exposure. Unlike continuous infusion, steady-state concentrations may not be achieved during a single dosing cycle but can be reached through repeated...
319
01:22Modified-Release Drug Delivery Systems: Drug Release Characteristics
89
Drug release from modified-release dosage forms is designed to achieve specific therapeutic effects by controlling the rate and extent of drug release. The classification of these drug release systems is based on key pharmacokinetic assumptions: drug disposition follows first-order kinetics, drug release is the rate-limiting step in absorption, and the released drug is rapidly and completely absorbed.There are four major models of drug release patterns. The first model is the slow zero-order...
89
01:19Modified-Release Drug Delivery Systems: Rate-Programmed II
58
Rate-programmed drug delivery systems release drugs in a controlled manner to maintain therapeutic levels. Three main designs include reservoir, matrix, and hybrid systems.Reservoir systems consist of a drug core enclosed within a membrane that controls drug release. In non-swelling reservoir systems, polymers like ethyl cellulose or polymethacrylates are used. These do not hydrate in aqueous media and control release through membrane thickness, porosity, or insolubility. This type includes...
58
01:11Oral Drug Delivery Systems: Delayed-Release Systems
80
Delayed-release drug delivery systems are specialized pharmaceutical formulations designed to postpone the release of active compounds until the drug reaches a specific region of the gastrointestinal (GI) tract, typically the intestine. These systems are essential for drugs that may cause gastric irritation, are unstable in acidic environments, or need to exert therapeutic effects locally in the intestinal or colonic regions.The core feature of delayed-release systems is the use of enteric...
80
01:57Meiosis II
209.7K
Meiosis II is the second and final stage of meiosis. It relies on the haploid cells produced during meiosis I, each of which contain only 23 chromosomes—one from each homologous initial pair. Importantly, each chromosome in these cells is composed of two joined copies, and when these cells enter meiosis II, the goal is to separate such sister chromatids using the same microtubule-based network employed in other division processes. The result of meiosis II is two haploid cells, each...
209.7K