Introduction: The objective of this study was to evaluate the actual association between velamentous cord insertion (VCI) and twin-twin transfusion syndrome (TTTS) in the native cohort concerning the natural history of monochorionic twin pregnancies. Material and Methods: All monochorionic diamniotic twin pregnancies who received prenatal care from <16 weeks of gestation until delivery at our center between 2004 and 2013 were included in this retrospective cohort study. Macroscopically defined cord insertion site was recorded as velamentous, marginal, or central. The effects of VCI on TTTS and a composite of adverse outcomes, including abortion, death, and neurological morbidities ≤28 days of age, were evaluated with a multiple logistic regression model. Results: A total of 357 monochorionic diamniotic twin pregnancies were analyzed. VCI in both twins was noted in 2.5% of cases and VCI in at least one twin was noted in 22.1% of cases. The incidence of TTTS was 8.4%; the incidence of a composite of adverse outcomes in at least one twin was 9.8%. There was no correlation between VCI and TTTS as well as a composite of adverse outcomes. Discussion: VCI in monochorionic twin pregnancies was not a risk factor for TTTS and severe perinatal morbidities.

Introduction: This study aimed to determine the incidences of feto-fetal transfusion syndrome (FFTS) and perinatal outcomes in triplet gestations with monochorionic placentation. Materials and Methods: In this retrospective cohort study, we evaluated the incidences of FFTS and perinatal outcomes at 28 days of age in cases of triplet gestations with monochorionic placentation who visited our centers before 16 weeks of gestation and delivered over a period of 11 years. Results: In 41 triplet gestations (17 monochorionic triamniotic, 22 dichorionic triamniotic, 1 dichorionic diamniotic, and 1 monochorionic monoamniotic), the incidence of FFTS was 17.1%, and the median gestational age at FFTS diagnosis was 19 weeks. In 123 triplets, the incidences of fetal death and neonatal death at 28 days of age were 8.1 and 0.9%, respectively. None of the surviving infants had grade 3 or 4 intraventricular hemorrhage, while cystic periventricular leukomalacia occurred in 6 of 113 infants (5.3%). The incidence of poor outcomes (death or any major neurological complication at 28 days of age) was 13.8%. Discussion: Seventeen percent of triplet pregnancies with monochorionic placentation developed FFTS, and 14% had a poor outcome. Therefore, triplet gestations with monochorionic placentation should be followed carefully.

TPS assessment of AoP and MLA in the second stage of labor was useful for predicting the time remaining in labor and had higher predictive value than did digital vaginal examination in nulliparous women. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Aim: The aim of this study was to evaluate the long-term outcomes of very low birthweight twins by chorionicity and to identify the perinatal predictors for outcomes in the era of laser surgery for twin-twin transfusion syndrome. Material and Methods: This was a retrospective single-center cohort study of twin pregnancy infants <1500 g from 2003 through 2010. During the study period, laser surgery was performed on cases of twin-twin transfusion syndrome. The composite of adverse outcomes at 3 years of age was defined, including death, cerebral palsy, and developmental delay. The association between perinatal factors and adverse outcomes was evaluated by multiple logistic regression analysis. Results: A total of 162 infants (79 dichorionic diamniotic twins [DCDA] and 83 monochorionic diamniotic twins [MCDA]) were included in this study. Laser surgery was performed on 11 cases. The rate of adverse outcomes was 13.9% for DCDA and 26.5% for MCDA. The incidence of each outcome for DCDA and MCDA was: cerebral palsy, 1.3% and 4.8%; developmental delay, 8.9% and 9.6%; and death, 3.8% and 14.5%. Gestational age at birth (adjusted odds ratio: 0.69; 95% confidence interval, 0.57-0.84); and anemia at birth (adjusted odds ratio, 10.64; 95% confidence interval, 1.69-66.9) were independent risk factors, whereas chorionicity did not have significance for outcomes. Conclusion: The long-term outcome of very low birthweight MCDA was almost identical to that of DCDA. Gestational age and anemia at birth were independent risk factors for adverse outcomes.

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