Planned delivery at 37 weeks in twins: a systematic review and meta-analysis of randomized controlled trials

Objective: To evaluate the effects of planned delivery at 37 weeks in women with twin gestations compared to expectant management.

Methods: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs). Searches were performed in electronic databases. We included all RCTs of uncomplicated early term twin gestations with intact membranes who were randomized to planned delivery at 37 weeks or control (i.e. expectant management until at least 38⁰ weeks). The primary outcome was the rate of cesarean delivery.

Results: Two trials (271 women) were analyzed. Women with twin gestations who had planned delivery at 37 weeks had similar rates of cesarean delivery compared to controls [51.9 versus 49.3%; relative risk (RR): 1.05, 95% confidence interval (CI): 0.83–1.32]. Furthermore, no differences in all secondary outcomes were detected, except for a significantly lower rate of serious adverse infant outcomes in the women who had planned delivery at 37 weeks compared to controls (4.7 versus 12.2%; RR: 0.39, 95% CI: 0.20–0.76).

Conclusions: Planned delivery at 37 weeks in twins is associated with a similar risk of cesarean delivery and lower risk of serious adverse infant outcomes, compared to expectant management until at least 38 weeks.