Early prognostic factors of outcomes in monochorionic twin pregnancy: systematic review and meta-analysis

Mackie, Fiona L.; Hall, Matthew J.; Morris, RK; Kilby, Mark D.

doi:10.1016/j.ajog.2018.05.008

Cited by 33 publications

(24 citation statements)

References 69 publications

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“…To date, there are no effective screening tests to determine adverse outcomes for monochorionic twins in the first trimester [19]. At the early second trimester of 16 to 18 weeks of gestation, it has been reported that intertwin differences in anthropometric measurements such as abdominal circumference, femur length, head circumference, and fetal weight could not predict progression to TTTS, or composite neonatal outcomes including respiratory distress syndrome, intraventricular hemorrhage, an Apgar score less than 7, necrotizing enterocolitis, early-onset sepsis, and neonatal death [20].…”

Section: Discussionmentioning

confidence: 99%

Twin amniotic fluid discordance below 26 weeks of gestation for predicting adverse outcomes

Fujisaki,

Furukawa,

Sameshima

2021

Clin. Exp. Obstet. Gynecol.

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To identify the threshold of monochorionic twins with amniotic luid discordance (TAFD) below 26 weeks for predicting progression to adverse outcomes. Method: A retrospective study involving 68 women of monochorionic twins that do not meet fetoscope laser photocoagulation criteria was conducted. The TAFD was calculated as the vertical pocket of Twin 1 minus that of Twin 2, and the maximum TAFD in any period from 14 weeks to below 26 weeks was identified. We then calculated the ratio of the vertical pocket of Twin 1 to that of Twin 2 as the maximum TAFD ratio. We attempted to elucidate the cut-o f value of the maximum TAFD ratio for adverse outcomes including cases that progressed to twin-twin transfusion syndrome (TTTS) a ter 26 weeks, twin anemia-polycythemia sequence, or neurologic abnormalities. Results: There were 21 cases of selective intrauterine growth restriction (sIUGR), 4 cases of twins that developed TTTS, one case of twins that developed TTTS with neurologic abnormalities, and 4 cases of twins that developed neurologic abnormalities. The median maximum TAFD ratio of the study group was 1.5. ROC curve analysis showed that a maximum TAFD ratio of 1.9 was the optimal cut-o f value. In cases where the maximum TAFD ratio was greater than 1.9, the odds ratio for adverse outcomes was 15.4 when considering the presence of sIUGR. All cases of twins with neurological abnormalities had a maximum TAFD ratio greater than 1.9. Conclusion: Maximum TAFD ratio greater than 1.9 below 26 weeks increased adverse outcomes in monochorionic twins.

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Section: Discussionmentioning

confidence: 99%

Twin amniotic fluid discordance below 26 weeks of gestation for predicting adverse outcomes

Fujisaki,

Furukawa,

Sameshima

2021

Clin. Exp. Obstet. Gynecol.

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“…Although ethnicity was not an exclusion criterion, it was only possible to include one ethnicity in this cohort which is a limitation, but does mean that ethnicity was not a confounding factor [24]. One reason for this may be that Caucasian women have been shown to possibly be at higher risk for TTTS [23]. Continued research in this area, with larger cohorts in different countries using translated questionnaires with appropriate validation is required.…”

Section: Discussionmentioning

confidence: 99%

Parental attachment and depressive symptoms in pregnancies complicated by twin-twin transfusion syndrome: a cohort study

Mackie

Pattison

Janković

et al. 2019

BMC Pregnancy Childbirth

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BackgroundTwin-twin transfusion syndrome (TTTS) is a highly morbid condition in which treatment exists, but the pregnancy remains high-risk until delivery. It may have serious sequelae, including fetal death, and in the longer term, neurodevelopmental problems. The aim of this study is to assess antenatal and postnatal parental attachment and depressive symptoms in those with pregnancies affected by TTTS.MethodsCouples attending for fetoscopic laser ablation treatment of TTTS were asked to complete Condon’s Maternal/Paternal Antenatal/Postnatal Attachment Scale as appropriate, and the Edinburgh Depression Scale the day before ablation, 4 weeks post-ablation, and 6–10 weeks postnatally.Results25/27 couples completed the pre-ablation questionnaire (median gestational age 19 + 3 weeks [interquartile range 18 + 2–20 + 6]). 8/18 eligible couples returned the post-ablation questionnaire. 5/17 eligible couples returned the postnatal questionnaire. There was no significant difference in parento-fetal attachment when mothers were compared to fathers at each time point, however parento-fetal attachment did increase over time in mothers (p = 0.004), but not fathers. Mothers reported more depressive symptoms antenatally compared to fathers (p < 0.02), but there was no difference postnatally. 50% women reported Edinburgh Depression Scale scores above the cut-off (≥15) 4 weeks post-ablation. Over time maternal depressive symptoms decreased (p = 0.006), however paternal depressive symptoms remained the same.ConclusionsThis is the first attachment and depression study in a UK cohort of parents with pregnancies affected by TTTS. Although this was a small cohort and the questionnaires used had not been validated in these circumstances, the results suggest that centres caring for these couples should be aware of the risk of maternal and paternal antenatal depression, and screen and refer for additional psychological support. Further work is needed in larger cohorts.Trial registrationISRCTN 13114861 (retrospectively registered).

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“…Es wurden einige frühe Ultraschallzeichen (Diskordanz in der Scheitel-Steiß-Länge und Nackentransparenz sowie Ductus-venosus-Pathologie) als Prädiktoren für ein späteres TTTS beschrieben [30,31]. Diese haben den Nachteil des geringen positiven Vorhersagewertes.…”

Section: Schwangerschaftsausgangunclassified

Zwillingstransfusionssyndrom

Bamberg¹,

Hecher²

2019

Geburtshilfe Frauenheilkd

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Early prognostic factors of outcomes in monochorionic twin pregnancy: systematic review and meta-analysis

Cited by 33 publications

References 69 publications

Twin amniotic fluid discordance below 26 weeks of gestation for predicting adverse outcomes

Twin amniotic fluid discordance below 26 weeks of gestation for predicting adverse outcomes

Parental attachment and depressive symptoms in pregnancies complicated by twin-twin transfusion syndrome: a cohort study

Zwillingstransfusionssyndrom

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