Does site of cord insertion increase risk of adverse outcome, twin‐to‐twin transfusion syndrome and discordant growth in monochorionic twin pregnancy?

Couck, Isabel; Tawfic, N. Mourad; Deprest, Jan; Catte, Luc De; Devlieger, Roland; Lewi, Liesbeth

doi:10.1002/uog.18926

Cited by 38 publications

(40 citation statements)

References 33 publications

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“…Monitoring of Type‐III sFGR is particularly challenging since IUD is unpredictable and the risk of neurological injury to the larger twin is substantial. Known adverse predictors in sFGR include earlier gestational age at diagnosis, ductus venosus Z ‐score, cord insertion site and fetal weight discrepancy, but further development of prognostic markers for severe sFGR is needed. In general, severe sFGR with normal venous Doppler can be managed expectantly with frequent Doppler, biophysical profile and cardiotocographic evaluations.…”

Section: Discussionmentioning

confidence: 99%

Perinatal outcome of monochorionic twin pregnancy complicated by selective fetal growth restriction according to management: systematic review and meta‐analysis

Townsend

D’Antonio

Sileo

et al. 2019

Ultrasound in Obstet & Gyne

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Type I sFGR is characterized by good perinatal outcome with expectant management, which represents the most reasonable management strategy for the large majority of affected cases. Pregnancies complicated by Type II and III sFGR treated with fetoscopic laser ablation had higher mortality but lower morbidity compared to those managed expectantly, supporting the use of fetal therapy at gestations remote from neonatal viability - with scarce data on outcome following selective reduction. However, in view of the lack of evidence from randomized controlled trials, prenatal management of sFGR should be individualized according to gestational age at diagnosis, severity of growth discordance and magnitude of Doppler anomalies. This article is protected by copyright. All rights reserved.

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Section: Discussionmentioning

confidence: 99%

Perinatal outcome of monochorionic twin pregnancy complicated by selective fetal growth restriction according to management: systematic review and meta‐analysis

Townsend

D’Antonio

Sileo

et al. 2019

Ultrasound in Obstet & Gyne

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“…It has been reported that VCI may be detected at 16 weeks' gestation and at 11‐14 weeks' gestation by gray scale and color Doppler . Previous reports analyzed the risk of TTTS with the data of CI at 16 weeks' gestation . Their PPV and NPV values for prediction of TTTS by VCI (22% and 90%) compared favorably with our results.…”

Section: Discussionmentioning

confidence: 99%

“…Previous reports analyzed the risk of TTTS with the data of CI at 16 weeks' gestation . Their PPV and NPV values for prediction of TTTS by VCI (22% and 90%) compared favorably with our results. Improved screening techniques in the first trimester may identify high‐risk MCDA twins who require more stringent follow‐up and management, resulting in an improved prognosis.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Several authors have reported velamentous cord insertion (VCI) increases the risk of adverse outcomes such as TTTS, small‐for‐gestational age (SGA), severe birthweight discordance (BWD), and intrauterine fetal death (IUFD) in MCDA twins . Couck et al reported that VCI at 16 weeks in one or both MCDA twins independently predicts TTTS and adverse outcomes such as fetal/neonatal loss or preterm delivery prior to 32 weeks . However, there is some controversy with respect to the reliability of ultrasound determination of the cord insertion (CI) site, and it is suggested that it is difficult to differentiate VCI from marginal cord insertion (MCI) in the first trimester .…”

Section: Introductionmentioning

confidence: 99%

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Impact of first trimester determination of abnormal cord insertion on twin‐to‐twin transfusion syndrome and other adverse outcomes in monochorionic diamniotic twins: A retrospective cohort study

et al. 2020

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Objective To assess the influence of abnormal cord insertion (CI) detected by first trimester ultrasonography on the development of twin‐to‐twin transfusion syndrome (TTTS) in monochorionic diamniotic (MCDA) twins. Method In this retrospective cohort study, consecutive patients with MCDA twins who underwent fetal ultrasound screening in the first trimester between January 2011 and January 2017 were enrolled. The CI sites were evaluated between 11 + 0 and 13 + 6 weeks' gestation. All twin pairs were assigned to the abnormal CI group (twin pair with velamentous cord insertion (VCI) and/or marginal cord insertion (MCI) in one or both twins) or the normal CI group (twin pair with both normal CI). The relationships of adverse outcomes in two groups were analyzed. Results A total of 109 MCDA twin pairs were examined; 15 cases were classified into the abnormal CI group and 94 cases into the normal CI group. The incidence of TTTS was significantly higher in the abnormal than in the normal CI group (26.7% vs 7.45%, P = .04). In patients who developed TTTS, all donors had VCI. Conclusion Ultrasound evaluation of abnormal CI at 11 + 0 to 13 + 6 weeks' gestation in MCDA twins is valuable in the assessment of the risk for TTTS.

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Natural evolution and risk factors for adverse outcome in selective intrauterine growth restriction under expectant management: A retrospective observational study

Chen

Zhou

Zhang

et al. 2023

Intl J Gynecology & Obste

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Selective intrauterine growth restriction (sIUGR) accounts for approximately 10%-15% of monochorionic diamniotic (MCDA) twins and is one of the most severe complications. 1 Selective IUGR is associated with increased perinatal mortality rate, poor neurological outcome, and higher incidence of endocrine and metabolic diseases, as well as cardiovascular dysfunction in adulthood. 2 The pathogeneses of sIUGR rely not only on the presence of gross placental structure factors, such as abnormal placental sharing and aberrant cord insertion, but also on the magnitude and direction of blood-flow interchange through the placental anastomoses. 3 The umbilical artery (UA) Doppler flow pattern of the smaller twin has been used for classifying

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Does site of cord insertion increase risk of adverse outcome, twin‐to‐twin transfusion syndrome and discordant growth in monochorionic twin pregnancy?

Cited by 38 publications

References 33 publications

Perinatal outcome of monochorionic twin pregnancy complicated by selective fetal growth restriction according to management: systematic review and meta‐analysis

Perinatal outcome of monochorionic twin pregnancy complicated by selective fetal growth restriction according to management: systematic review and meta‐analysis

Impact of first trimester determination of abnormal cord insertion on twin‐to‐twin transfusion syndrome and other adverse outcomes in monochorionic diamniotic twins: A retrospective cohort study

Natural evolution and risk factors for adverse outcome in selective intrauterine growth restriction under expectant management: A retrospective observational study

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