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• W2312271848 abstract "ObjectivesConcomitant complete twin molar gestations with coexisting fetus [CMCF] occur 1 of 22,000-100,000 pregnancies. This diagnosis is optimally made during ultrasonographic evaluation in early gestation. We reviewed outcomes of CMCF gestations that continued past 34 weeks in order to guide recommendations for delivery.MethodsMEDLINE, EMBASE, and the Cochrane Library were systematically searched. Studies were included if they described pregnancies delivering a CMCF at and beyond 34 weeks. Two authors independently determined eligibility and abstracted data. Primary outcome was to determine any benefit of promoting delivery. Variables included hyperemesis, hypertension [HTN], preeclampsia [PEC], hyperthyroidism, vaginal bleeding [VB]: antepartum and/or post partum hemorrhage, and persistent disease. Deliveries were placed in 3 groups: 34 to 36 completed weeks, 37 weeks, and 39 weeks. Statistical analysis was done using Pearson’s chi-square test, Fisher’s exact test, and logistic regression where appropriate with p<0.05 as significance.ResultsA total of 167 case reports, case series, and retrospective cohort studies were identified. All diagnoses were made initially via ultrasound evaluation; 51 cases in 45 studies met inclusion criteria for analysis. A total of 2 subjects developed hyperemesis, 11 developed HTN, 8 developed PEC, 1 developed hyperthyroidism, 26 experienced VB, 10 had persistent disease requiring chemotherapy, 6 underwent hysterectomy, and all patients were cured via delivery, methotrexate or hysterectomy. The only association of significance was a decrease in vaginal bleeding in women delivering after 39 weeks (OR 0.177 [CI 0.033-0.940] p = 0.038). Logistic regression revealed no relationship between gestational age of delivery and the rate of any comorbidity considered.ConclusionsIn gestations complicated by concomitant twin mole with coexisting fetus, analysis failed to show that delivery prior to term decreased perinatal morbidities and post-partum complications. In the absence of evidence of improved outcome, it may be reasonable to await spontaneous labor at term to avoid complications of iatrogenic preterm delivery. ObjectivesConcomitant complete twin molar gestations with coexisting fetus [CMCF] occur 1 of 22,000-100,000 pregnancies. This diagnosis is optimally made during ultrasonographic evaluation in early gestation. We reviewed outcomes of CMCF gestations that continued past 34 weeks in order to guide recommendations for delivery. Concomitant complete twin molar gestations with coexisting fetus [CMCF] occur 1 of 22,000-100,000 pregnancies. This diagnosis is optimally made during ultrasonographic evaluation in early gestation. We reviewed outcomes of CMCF gestations that continued past 34 weeks in order to guide recommendations for delivery. MethodsMEDLINE, EMBASE, and the Cochrane Library were systematically searched. Studies were included if they described pregnancies delivering a CMCF at and beyond 34 weeks. Two authors independently determined eligibility and abstracted data. Primary outcome was to determine any benefit of promoting delivery. Variables included hyperemesis, hypertension [HTN], preeclampsia [PEC], hyperthyroidism, vaginal bleeding [VB]: antepartum and/or post partum hemorrhage, and persistent disease. Deliveries were placed in 3 groups: 34 to 36 completed weeks, 37 weeks, and 39 weeks. Statistical analysis was done using Pearson’s chi-square test, Fisher’s exact test, and logistic regression where appropriate with p<0.05 as significance. MEDLINE, EMBASE, and the Cochrane Library were systematically searched. Studies were included if they described pregnancies delivering a CMCF at and beyond 34 weeks. Two authors independently determined eligibility and abstracted data. Primary outcome was to determine any benefit of promoting delivery. Variables included hyperemesis, hypertension [HTN], preeclampsia [PEC], hyperthyroidism, vaginal bleeding [VB]: antepartum and/or post partum hemorrhage, and persistent disease. Deliveries were placed in 3 groups: 34 to 36 completed weeks, 37 weeks, and 39 weeks. Statistical analysis was done using Pearson’s chi-square test, Fisher’s exact test, and logistic regression where appropriate with p<0.05 as significance. ResultsA total of 167 case reports, case series, and retrospective cohort studies were identified. All diagnoses were made initially via ultrasound evaluation; 51 cases in 45 studies met inclusion criteria for analysis. A total of 2 subjects developed hyperemesis, 11 developed HTN, 8 developed PEC, 1 developed hyperthyroidism, 26 experienced VB, 10 had persistent disease requiring chemotherapy, 6 underwent hysterectomy, and all patients were cured via delivery, methotrexate or hysterectomy. The only association of significance was a decrease in vaginal bleeding in women delivering after 39 weeks (OR 0.177 [CI 0.033-0.940] p = 0.038). Logistic regression revealed no relationship between gestational age of delivery and the rate of any comorbidity considered. A total of 167 case reports, case series, and retrospective cohort studies were identified. All diagnoses were made initially via ultrasound evaluation; 51 cases in 45 studies met inclusion criteria for analysis. A total of 2 subjects developed hyperemesis, 11 developed HTN, 8 developed PEC, 1 developed hyperthyroidism, 26 experienced VB, 10 had persistent disease requiring chemotherapy, 6 underwent hysterectomy, and all patients were cured via delivery, methotrexate or hysterectomy. The only association of significance was a decrease in vaginal bleeding in women delivering after 39 weeks (OR 0.177 [CI 0.033-0.940] p = 0.038). Logistic regression revealed no relationship between gestational age of delivery and the rate of any comorbidity considered. ConclusionsIn gestations complicated by concomitant twin mole with coexisting fetus, analysis failed to show that delivery prior to term decreased perinatal morbidities and post-partum complications. In the absence of evidence of improved outcome, it may be reasonable to await spontaneous labor at term to avoid complications of iatrogenic preterm delivery. In gestations complicated by concomitant twin mole with coexisting fetus, analysis failed to show that delivery prior to term decreased perinatal morbidities and post-partum complications. In the absence of evidence of improved outcome, it may be reasonable to await spontaneous labor at term to avoid complications of iatrogenic preterm delivery." @default.
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• W2312271848 date "2015-04-01" @default.
• W2312271848 modified "2023-10-16" @default.
• W2312271848 title "2089538 A Systematic Review Of Concomitant Twin Complete Molar Gestations At Term And Recommendations For Care" @default.
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