Diamnionic Monochorionic Twin Gestations: An Overview

Gaziano, Emanuel P.; Lia, Julian E. De; Kuhlmann, Randall S.

doi:10.3109/14767050009053430

Cited by 11 publications

(15 citation statements)

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“…In this study, 35.6% of the pregnancies were monochorionic; although slightly higher, this is not out of keeping with what is currently being reported (Gaziano, 2000;Victoria, 2001). Our incidence of monochorionic pregnancies may reflect that the study center is a major perinatal referral center for the Central East region of Ontario and is likely to draw in more cases.…”

Section: Discussioncontrasting

confidence: 84%

Evaluating 2 Year Outcome in Twins ≤ 30 Weeks Gestation at Birth: A Regional Perinatal Unit's Experience

et al. 2001

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With improved technology in assisted reproductive medicine, there has been an absolute increase in the numbers of twin pregnancies with an associated increase in perinatal mortality and morbidity. This increase in perinatal mortality and morbidity is largely due to a higher incidence of delivering preterm as compared to singletons. Twin pregnancies have their unique complications that include abnormal placental communication and discordant growth which are associated with perinatal mortality and morbidity. The objectives of this study were two-fold: i) to determine if the morbidity/mortality outcome at 18–24 months corrected age seen in a cohort of twins born between 24–30 weeks gestation was significantly different as compared to singleton preterm infants of the same gestation; and ii) to determine and evaluate any differences between monochorionic (MC) and dichorionic (DC) twins. Twins 24–30 weeks gestation at birth born between 01/01/97–30/06/99 were identified and prospectively followed to 18–24 months corrected age (c.a.). They were matched with a singleton infant of the same gender and within 1 week of the same gestation. Obstetrical, neonatal and neurodevelopmental data were gathered and analyzed. The primary outcome was death or the presence of a severe neurodevelopmental deficit at 18–24 months corrected age. Of the 56 sets of twins identified, 52 sets were followed prospectively with 101 infants available for matching. In this cohort, twin pregnancies had a lower incidence of pregnancy-induced hypertension and premature rupture of membranes than singletons (p < 0.05). The two groups were comparable in neonatal characteristics. The incidence of death or severe disability was 29.7% in twins vs. 22.8% in singletons (p = 0.337, Fisher's exact test). The major area of deficit was in the cognitive category for both groups, 9.9% vs. 7.9% respectively. MC twins made up 35.6%; DC twins 64.4%. Twin to twin transfusion syndrome (TTTS) occurred in 6.9%. Discordant growth occurred more frequently in MC pregnancies (p = 0.016). MC twins tended to be more premature, lower in birth weight, and experience neonatal morbidity in the form of patent ductus arteriosus and sepsis (p < 0.05) as compared to DC twins. However, the primary outcome of death or severe neurodevelopmental deficit at 18–24 months c.a. was not significantly different between the two groups, 38.9% (MC) vs. 24.6% (DC), (p = 0.173, Fisher's exact test). Neurodevelopmental morbidity or mortality in twins with TTTS was 42%. Mortality and severe neurodevelopmental morbidity were not significantly higher in twins as compared to singletons in this cohort. However, the trend is slightly higher in twins, which may have clinical significance. Though not statistically significant, the incidence of 38.9% in adverse outcome with MC twins may be clinically significant. With the number of twins steadily increasing, further monitoring is required to determine future directions in intervention and research. Early recognition of monochorionicity remains essential to optimize care and neurodevelopment for these infants.

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Section: Discussioncontrasting

confidence: 84%

Evaluating 2 Year Outcome in Twins ≤ 30 Weeks Gestation at Birth: A Regional Perinatal Unit's Experience

et al. 2001

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“…Recent reports, however, have suggested that selective intrauterine growth restriction (sIUGR) is also a condition associated with an increased risk of intrauterine fetal death (IUFD) for one or both twins, and an increased risk of neurologic morbidity in the larger twin regardless of whether the fetus with IUGR survives [7]. Selective intrauterine growth restriction has been reported to occur in 12% to 25% of all MC pregnancies [8,9], and this wide variation is due to the lack of a uniform definition. In most studies, sIUGR is defined as one twin having an estimated fetal weight (EFW) below the 10th or 5th percentile for gestational age (GA) while the other twin grows normally.…”

Section: Introductionmentioning

confidence: 99%

Twin chorionicity and the risk of adverse perinatal outcome

Acosta-Rojas

Becker

Muñoz‐Abellana

et al. 2007

International Journal of Gynecology & Obstetrics

187

147

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“…Twin‐to‐twin transfusion syndrome (TTTS) with circulatory imbalance between the anastomoses will develop in 10–15% of MC gestations and is associated with a poor outcome if untreated5, 6. Other complications such as preterm labor, intrauterine growth restriction (IUGR) and lethal congenital anomalies also occur more frequently in MC twins2, 7, 8. In twin pregnancies Doppler assessment of the fetal circulation has proved useful in diagnosing IUGR and fetal anemia9, in diagnosing and grading TTTS10–12, and in predicting (adverse) outcome in the presence of TTTS10, 13.…”

Section: Introductionmentioning

confidence: 99%