Perinatal outcome according to chorionicity in twins — a Polish multicenter study

Abstract

Objectives: The aim of the study was to analyze the perinatal outcome of twin gestations and estimate the influence of chorionicity on the outcome in a large cohort of twin pregnancies in Poland. Material and methods:A retrospective analysis of 465 twin deliveries in 6 Polish centers in 2012 was conducted. Baseline characteristics, the course of pregnancy and labor, as well as the neonatal outcome were analyzed in the study group and according to chorionicity. Results:A total of 356 twin pregnancies were dichorionic (DC group) (76.6%), and 109 were monochorionic (MC group) (23.4%). There were no differences in the occurrence of pregnancy complications according to chorionicity, except for IUGR of at least one fetus (MC 43.1% vs. DC 34.6%; p = 0.003). 66.5% of the women delivered preterm, significantly more in the MC group (78% vs. 62.9%; p = 0.004). Cesarean delivery was performed in 432 patients (92.9%). Mean neonatal birthweight was statistically lower in the MC group (2074 g vs. 2370 g; p < 0.001). Perinatal mortality of at least one twin was 4.3% (2.8% in the DC group vs. 9.2% in the MC group; p = 0.004). Neonatal complications, including NICU admission, respiratory disorders, and infections requiring antibiotic therapy, were significantly more often observed among the MC twins. Conclusions:The overall perinatal outcome in the presented subpopulation of Polish twins and its dependence on chorionicity is similar to the reports in the literature. Nevertheless, the rates of preterm and cesarean deliveries remain higher. It seems that proper counselling of pregnant women and education of obstetricians may result in reduction of these rates.

Association between chorionicity and preterm birth in twin pregnancies: a systematic review involving 29 864 twin pregnancies

“…Quality of the included studies is shown in Figure 2. In all, 97% of the studies were low risk for study selection (38/ 39), 4,14-38,40-51 10% (4/39) were low risk for comparability 28,32,40,49 and all studies were low risk for study outcome (100%). 4, One study had a medium risk of bias for study selection (3%), 39 32 studies for comparability 4,14,15,17,[20][21][22][23][24][25][26][27][29][30][31][33][34][35][36][37][38][39][41][42][43][44][45][46][47][48]50,51 and none of the studies had a medium risk of bias for outcome.…”

“…28,41 Seven of the 39 studies (18%) reported on pregnancies which are asymptomatic for preterm labour 20,22,34,38,45,50,51 whereas 31 studies reported on pregnancies which were both symptomatic and asymptomatic for preterm labour. 4,[14][15][16][17][18][19]21,23,24,[26][27][28][29][30][31][32][33][35][36][37][39][40][41][42][43][44][46][47][48][49] Seven studies (18%) reported on treatment or prophylaxis for preterm labour. 36,37,39,42,48,50,51 Around 80% (31/39) of the studies reported on both spontaneous and iatrogenic preterm birth 4,38,…”

“…36,37,39,42,48,50,51 Around 80% (31/39) of the studies reported on both spontaneous and iatrogenic preterm birth 4,38,39,41,42,46,47,49 , and 26% of the studies (10/39) reported on spontaneous preterm birth. 23,37,38,40,[43][44][45]48,50,51 Eleven studies reported on preterm birth ≤28 weeks (28%), 4,18,20,23,26,32,38,41,44,47,48 23 studies on preterm birth ≤32 weeks (59%), 4,[14][15][16]19,20,[23][24][25][27][28][29]32,[36][37]…”

“…23,37,38,40,[43][44][45]48,50,51 Eleven studies reported on preterm birth ≤28 weeks (28%), 4,18,20,23,26,32,38,41,44,47,48 23 studies on preterm birth ≤32 weeks (59%), 4,[14][15][16]19,20,[23][24][25][27][28][29]32,[36][37][38][39]41,45,[47][48][49][50] 22 studies on preterm birth ≤34 weeks (56%) 4,15,[18][19][20]24,[26][27]…”

Postnatal condition of the second twin in respect to mode of delivery, chorionicity and type of fetal growth

“…6,7 Some authors reported that factors such as chorionicity, mode of delivery, type of fetal growth (discordant or symmetric), and birth mass worsen perinatal outcomes and increase the rate of neonatal complications in the second twin compared to the first one. [8][9][10] On the other hand, broad trials have been conducted which did not show the superiority of CS vs VD in terms of complications in neonates, especially in the absence of risk factors and when the first twin is in the cephalic presentation. [11][12][13] The authors of the meta-analysis from 2011, which included nearly 40,000 twin pairs, concluded that, in the absence of risk factors, VD is safer than CS for the first twin but for the second twin, the mode of delivery had no effect on perinatal outcome.…”