Can progestogens improve twin pregnancy outcomes?

We will discuss “Effectiveness of progestogens to improve perinatal outcome in twin pregnancies: an individual participant data meta-analysis” by a Global Obstetrics Network (GONet) collaboration from 25 March 2015 for 7 days.

*This paper has been made FREE-TO-VIEW. We are now on LinkedIn too: http://linkd.in/1BVrpad (simply ask to join)!

Linked article: This article is commented on by A Gimovsky and V Berghella,There is still insufficient data to recommend screening twin pregnancies with transvaginal ultrasound cervical length, but this might change soon!

Start date: 25 March 2015 (the discussion will open for 7 days)

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

Host: @BlueJCHost

Platforms: Twitter and LinkedIn

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 every 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).

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

Scenario

A woman attends your antenatal clinic at 14 weeks of gestation with dichorionic twins after in vitro fertilization. This is her forth pregnancy and she had two early miscarriages and one late miscarriage at 22 weeks. She asks: ‘doctor, is there anything I could do to prevent me losing my babies again?’

Description of research

Participants Women with twin pregnancies
Intervention 17Pc or vaginal natural progesterone
Comparison Placebo or no treatment
Outcomes

Primary composite outcomes

For vaginal progesterone: perinatal death, respiratory distress syndrome, intraventricular haemorrhage, or necrotising enterocolitis.

For 17Pc: all outcomes for vaginal progesterone, plus bronchopulmonary dysplasia and culture-proven sepsis.

Study design Individual participant data meta-analysis (IPDMA)

Discussion Points

  • How would you currently manage the woman in the above scenario?
  • What are the differences between IPDMA and aggregated data meta-analysis (ADMA)?
  • What are the advantages and disadvantages of IPDMA and ADMA, respectively? (Chapter 19, Cochrane Handbook for Systematic Reviews of Interventions, version 5.1.0, http://www.cochrane-handbook.org).
  • How did the authors manage the different baseline characteristics and interventions of the included trials?
  • Are there any alternative methods to manage these differences?
  • Critically appraise the study using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist (www.prisma-statement.org).
  • Can you briefly summarise the results of this study? How would the results of this study influence your practice?

Suggested reading

  • Chapter 19, Cochrane Handbook for Systematic Reviews of Interventions verson 5.1.0, http://www.cochrane-handbook.org/
  • Riley RD, Lambert PC, Abo-Zaid G. Meta-analysis of individual participant data: rationale, conduct, and reporting. BMJ. 2010 Feb 5;340:c221.

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.