When is the best time to deliver twins?

We will discuss “Stillbirth in twins, exploring the optimal gestational age for delivery: a retrospective cohort study by Wood and co-workers from 26 November 2014 for 7 days.

*This paper is now free-to-view.

Linked article: This article is commented on by Owen J, p. 1291 in this issue of BJOG. To view this mini commentary visit http://dx.doi.org/10.1111/1471-0528.12867.

 ***An additional hosted session is now planned (hosted by @nnpulei9) at 11am in Kenya (GMT+3, 8am in the UK)***

Start date: 26 November 2014 (the discussion will open for 7 days)

First hosted discussion session(s) starts at: GMT 7pm (UK time)

Host: @BlueJCHost

Platforms: Twitter

The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of each month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues. You can access the slide set of this paper here (Data S1 powerpoint).

The discussion points are attached below (quoted from the published manuscript)

Scenario

A 36-year-old nulliparous Caucasian woman with dichorionic diamniotic twins attends your antenatal clinic to discuss her birth plan. The twins were conceived by in vitro fertilisation and are currently at 32 + 0 weeks of gestation. No cause has been found for this woman’s subfertility, and she has no other medical history. The latest fetal ultrasound scan shows that fetal growth and amniotic fluid volume are within the normal ranges. Fetal umbilical artery doppler results are normal for both twins. Both are in cephalic presentation. How would you counsel her?

 Description of research

Participants All twin births in Alberta, Canada from 1992-2007 in which the fetuses survived until >23 weeks
Intervention Delivery of twins at different gestational ages
Comparison Expectant management
Outcomes Stillbirths (fetal deaths at >23 weeks), neonatal deaths and Perinatal Risk Ratio
Study design A historical cohort study

Discussion Points

  • What are your current recommendations on the timing of delivery for twins? What are the reasons behind them?
  • How do your local stillbirth and neonatal death rates compared to the data reported in this study?
  • Critically appraise this studying using the Scottish Intercollegiate Guidelines Network (SIGN) Checklist for cohort studies (See checklist 3; http://bit.ly/1rzfjfD).
  • What are the advantages and disadvantages of using a historical cohort study to answer the current research question?
  • Can you summarise the available evidence in a single sentence?
  • How would the results of this study influence your practice?

Suggested reading

Dodd JM, Deussen AR, Grivell RM, Crowther CA. Elective birth at 37 weeks’ gestation for women with an uncomplicated twin pregnancy. Cochrane Database Syst Rev. 2014 Feb 10;2:CD003582.

For those who want to understand hashtags, this may be a useful guide. For an introduction to #BlueJC, please refer to BJOG 2013;120:657–60. Follow @BlueJCHostthis blog and our Facebook page to receive news about #BlueJC.