Paper for Discussion

Effectiveness of progestogens to improve perinatal outcome in twin pregnancies: an individual participant data meta-analysis. BJOG 2014: 122:27–37.To view this article online visit


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

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,
  • 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 (
  • Can you briefly summarise the results of this study? How would the results of this study influence your practice?

Suggested reading

  • Riley RD, Lambert PC, Abo-Zaid G. Meta-analysis of individual participant data: rationale, conduct, and reporting. BMJ 2010;340:c221.

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