Outcomes of monoamniotic twin pregnancies managed primarily in outpatient care—a Danish multicenter study

Madsen, Caroline B.; Søgaard, Kirsten; Zingenberg, Helle; Jørgensen, Finn Stener; Rosbach, Hanne; Hoseth, Eva; Pedersen, Lars Henning; Petersen, Olav Bjørn

doi:10.1111/aogs.13509

Cited by 11 publications

(11 citation statements)

References 22 publications

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“…Prefumo et al reported on 16 MCMA twin pregnancies with no major abnormalities, recruited at < 16 weeks' gestation between 2004 and 2013; the rates of fetal loss and perinatal death were 37.5% and 10.0%, respectively 27 . Madsen et al, in a multicenter study from Denmark, reported on 46 MCMA twin pregnancies with no major abnormalities, recruited at < 17 weeks' gestation between 2004 and 2013; the rates of fetal loss and perinatal death were 26.1% and 11.8%, respectively 28 . Glinianaia et al used two multicenter datasets in England, which covered births between 2000 and 2013, to report on 61 MCMA twin pregnancies with no major abnormalities in which chorionicity had been determined by ultrasound at a median gestational age of 13 (IQR, 12-14) weeks; the rates of fetal loss and perinatal death were 18.9% and 12.1%, respectively 29 .…”

Section: Comparison With Findings From Previous Studiesmentioning

confidence: 99%

Outcome of twin pregnancy with two live fetuses at 11–13 weeks' gestation

Litwińska

Syngelaki

Cimpoca-Raptis

et al. 2019

Ultrasound in Obstet & Gyne

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CONTRIBUTIONWhat are the novel findings of this work? This study of 6225 twin pregnancies with two live fetuses at 11-13 weeks' gestation and no major abnormalities, first, compares overall survival, fetal loss at < 24 weeks' gestation, perinatal death at ≥ 24 weeks, delivery at < 37 and < 32 weeks, and birth weight < 5 th percentile between dichorionic, monochorionic diamniotic and monochorionic monoamniotic twins, and, second, examines the potential impact of endoscopic laser surgery for severe twin-twin transfusion syndrome and/or selective fetal growth restriction on the outcome of monochorionic diamniotic twins. What are the clinical implications of this work?In twin pregnancy, determination of chorionicity and amnionicity at the routine 11-13-week scan is essential because this defines the subsequent pregnancy outcome and the need for surveillance and intervention. ABSTRACTObjectives To report and compare pregnancy outcome in dichorionic (DC), monochorionic diamniotic (MCDA) and monochorionic monoamniotic (MCMA) twin pregnancies with two live fetuses at 11-13 weeks' gestation and to examine the impact of endoscopic laser surgery for severe twin-twin transfusion syndrome (TTTS) and/or selective fetal growth restriction (sFGR) on the outcome of MCDA twins.Methods This was a retrospective analysis of prospectively collected data on twin pregnancies undergoing routine ultrasound examination at 11-13 weeks' gestation between 2002 and 2019. In pregnancies with no major abnormalities, we compared overall survival, fetal loss at < 24 weeks' gestation, perinatal death at ≥ 24 weeks, delivery at < 37 and < 32 weeks, and birth weight < 5 th percentile between DC, MCDA and MCMA twins. ResultsThe study population of 6225 twin pregnancies with two live fetuses at 11-13 weeks' gestation with no major abnormalities included 4896 (78.7%) DC, 1274 (20.5%) MCDA and 55 (0.9%) MCMA twins. In DC twins, the rate of loss at < 24 weeks' gestation in all fetuses was 2.3%; this rate was higher in MCDA twins (7.7%; relative risk (RR), 3.258; 95% CI, and more so in MCMA twins (21.8%; RR, 9.289; 95% CI,). In DC twins, the rate of perinatal death at ≥ 24 weeks in all twins that were alive at 24 weeks was 1.0%; this rate was higher in MCDA twins (2.5%; RR, 2.456; 95% CI,) and more so in MCMA twins (9.3%; RR, 9.130; 95% CI,. In DC twins, the rate of preterm birth at < 37 weeks' gestation in pregnancies with at least one liveborn twin was 48.6%; this rate was higher in MCDA twins (88.5%; RR, 1.824; 95% CI, 1.760-1.890) and more so in MCMA twins (100%; RR, 2.060; 95% CI, 2.000-2.121). In DC twins, the rate of preterm birth at < 32 weeks was 7.4%; this rate was higher in MCDA twins (14.2%; RR, 1.920; 95% CI,) and more so in MCMA twins (26.8%; RR, 3.637; 95% CI,. In DC twin pregnancies with at least one liveborn twin, the rate of a small-for-gestational-age neonate among all liveborn twins was 31.2% and in MCDA twins this rate was higher (37.8%; RR, 1.209; 95% CI,; in MCMA twins, the rate was not significantly different (33.3%; RR, 1.067; 95...

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Section: Comparison With Findings From Previous Studiesmentioning

confidence: 99%

Outcome of twin pregnancy with two live fetuses at 11–13 weeks' gestation

Litwińska

Syngelaki

Cimpoca-Raptis

et al. 2019

Ultrasound in Obstet & Gyne

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“…The search identified 505 articles, of which 152 were assessed with respect to their eligibility for inclusion (Table S1) and 15 were included in the systematic review ( Figure 1, Table 1). These 15 studies included 888 MCMA twin pregnancies, of which 44 (88 fetuses) were affected by TTTS [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] . There was no randomized controlled trial comparing different management options (expectant vs laser vs cord occlusion vs amniodrainage) in MCMA twin pregnancies complicated by TTTS.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…GA, gestational age given as mean ± SD when more than one case of TTTS; NS, not specified. 11 Madsen (2019) 12 Anselem (2015) 13 Van Mieghem (2014) 14 Peeters (2014) 15 Murata (2013) 16 Suzuki (2013) 17 Morikawa (2012) 18 Baxi (2010) 19 Hack (2009) 20 Cordero (2006) 21 DeFalco (2006) 22 Heyborne (2005) 23 Demaria (2004) 24 Sau (2003) 25 Only first author's name is given. A study can be awarded a maximum of one star for each numbered item within selection and outcome categories.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

Outcome of twin‐to‐twin transfusion syndrome in monochorionic monoamniotic twin pregnancy: systematic review and meta‐analysis

Murgano

Khalil

Prefumo³

et al. 2020

Ultrasound in Obstet & Gyne

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Objectives To explore the outcome of monochorionic monoamniotic (MCMA) twin pregnancies affected by twin‐to‐twin transfusion syndrome (TTTS). Methods MEDLINE and EMBASE databases were searched for studies reporting the outcome of MCMA twin pregnancies complicated by TTTS. The primary outcome was intrauterine death (IUD); secondary outcomes were miscarriage, single IUD, double IUD, neonatal death (NND), perinatal death (PND), survival of at least one twin, survival of both twins and preterm birth (PTB) before 32 weeks' gestation. Outcomes were assessed in MCMA twins affected by TTTS not undergoing intervention and in those treated with amniodrainage, laser therapy or cord occlusion. Subgroup analysis was performed including cases diagnosed before 24 weeks. Random‐effects meta‐analysis of proportions was used to analyze the data. Results Fifteen cohort studies, including 888 MCMA twin pregnancies, of which 44 were affected by TTTS, were included in the review. There was no randomized trial comparing the different management options in MCMA twin pregnancies complicated by TTTS. In cases not undergoing intervention, miscarriage occurred in 11.0% of fetuses, while the incidence of IUD, NND and PND was 25.2%, 12.2% and 31.2%, respectively. PTB complicated 50.5% of these pregnancies. In cases treated by laser surgery, the incidence of miscarriage, IUD, NND and PND was 19.6%, 27.4%, 7.4% and 35.9%, respectively, and the incidence of PTB before 32 weeks' gestation was 64.9%. In cases treated with amniodrainage, the incidence of IUD, NND and PND was 31.3%, 13.5% and 45.7% respectively, and PTB complicated 76.2% of these pregnancies. Analysis of cases undergoing cord occlusion was affected by the very small number of included cases. Miscarriage occurred in 19.2%, while there was no case of IUD or NND of the surviving twin. PTB before 32 weeks occurred in 50.0% of these cases. Conclusions MCMA twin pregnancies complicated by TTTS are at high risk of perinatal mortality and PTB. Further studies are needed in order to elucidate the optimal type of prenatal treatment in these pregnancies. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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“…Their complication rates, on the other hand, are extremely high. Indeed, studies reporting on the outcome of monoamniotic twin pregnancies from the first trimester onwards show them to have significantly higher risks than do dichorionic or diamniotic twin pregnancies, with fetal or neonatal loss rates of up to 20–50%. The majority of these losses occur prior to 24 weeks' gestation, but even thereafter, the risk of fetal death remains as high as 5–10%, which is double the risk seen in monochorionic diamniotic twins.…”

mentioning

confidence: 99%

“…In contrast to diamniotic twins, only about one‐third of fetal deaths in monoamniotic twins are due to twin reversed arterial perfusion sequence, twin–twin transfusion syndrome, preterm birth or (pregnancy termination for) congenital anomalies, while the other two‐thirds are thought to be the result of acute cord occlusion and/or intertwin transfusional imbalances as a consequence of the near‐universal cord entanglement and the large intertwin placental anastomoses seen in these pregnancies.…”

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confidence: 99%