Persistance of adverse obstetric and neonatal outcomes in monochorionic twins after exclusion of disorders unique to monochorionic placentation

Leduc, Line; Takser, Larissa; Rinfret, Denyse

doi:10.1016/j.ajog.2005.04.007

Cited by 56 publications

(53 citation statements)

References 21 publications

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“…The results show that mean gestational age at delivery was significantly lower in the MC than in the DC group (33.7 vs. 35.3 weeks), which is similar to data presented by other authors [8,[10][11][12][13]. According to the literature, the rates of deliveries before 37 weeks of gestation in twins vary from 52 to 60% [14,15].…”

Section: Discussionsupporting

confidence: 79%

“…Similar results were presented by Leduc. In his study, the rate of preterm deliveries before 34 weeks of gestation was significantly higher in the MC group, while those before 30 weeks of gestation did not differ by chorionicity [10]. According to the literature, the rate of cesarean deliveries in twin gestations is higher than in singletons -it varies between 43 and 64% and does not differ significantly between DC and MC twins [10,13,14,[17][18][19].…”

Section: Discussionmentioning

confidence: 89%

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

et al. 2016

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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.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 89%

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

et al. 2016

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“…5 Finally, IUFDs among dichorionic twins does also exist. However, this risk is considerably higher in monochorionic twins 4,15 and highlights the special attention that is required for monochorionicity, which should translate into more intensive antenatal assessments. However, the prospective risk of IUFD that was found in our study does not indicate preterm elective delivery of monochorionic twins.…”

Section: Commentmentioning

confidence: 99%

“…[2][3][4] This risk is attributed to the inherent pathologic condition that is associated with delayed zygotic splitting that leads to the increased prevalence of fetal and placental malformations. However, in monochorionicdiamniotic pregnancies, the precise cause of the high rate of adverse perinatal outcomes in pregnancies that are not complicated by congenital anomalies, twin-twin transfusion syndrome (TTTS), and/or growth restriction is not clear.…”

mentioning

confidence: 99%

Prospective risk of intrauterine death of monochorionic-diamniotic twins

Simões¹,

Amaral²,

Lerman³

et al. 2006

American Journal of Obstetrics and Gynecology

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Objective: The purpose of this study was to calculate the prospective risk of fetal death in monochorionic-diamniotic twins. Study design: We evaluated 193 monochorionic diamniotic twin pregnancies that were followed and delivered after 24 weeks. Surveillance included cardiotocography and sonography performed at least once weekly. The prospective risk of fetal death was calculated as the total number of deaths at the beginning of the gestational period divided by the number of continuing pregnancies at or beyond that period. Results: The fetal death rate was 5 of 193 pregnancies (2.6%; 95% CI, 1.1, 5.9); the prospective risk of stillbirth per pregnancy after 32 weeks of gestation was 1.2% (95% CI, 0.3% -4.2%). Conclusion: Under intensive surveillance, the prospective risk of fetal death in monochorionicdiamniotic pregnancies after 32 weeks of gestation is much lower than reported and does not support a policy of elective preterm delivery. Ó 2006 Mosby, Inc. All rights reserved.Monochorionic twins, comprising approximately 20% of all spontaneous twins and nearly 5% of iatrogenic twins, 1 are at a substantial higher risk of perinatal morbidity and death than their bichorionic counterparts.2-4 This risk is attributed to the inherent pathologic condition that is associated with delayed zygotic splitting that leads to the increased prevalence of fetal and placental malformations. However, in monochorionicdiamniotic pregnancies, the precise cause of the high rate of adverse perinatal outcomes in pregnancies that are not complicated by congenital anomalies, twin-twin transfusion syndrome (TTTS), and/or growth restriction is not clear.Evidently, not all monochorionic twin pregnancies are complicated a priori. A recent analysis of a large cohort of 455 monochorionic twins showed that 181 (39.8%) twin pairs were considered ''uncomplicated'' (ie, without signs of TTTS and exhibiting appropriate and concordant growth in each of the structurally normal twins). 5 This subset of ''uncomplicated'' monochorionic twins, however, was found to be at a considerable excess

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“…Monochorionic twin pregnancies are at higher risk of adverse outcome than dichorionic twin pregnancies (Leduc et al, 2005;Morikawa et al, 2012;Sebire et al, 1997). Placental vascular anastomoses can lead to specific pregnancy complications, such as twin-to-twin transfusion syndrome (TTTS), selective intrauterine growth restriction, and death or neurologic damage of the surviving twin after sFD.…”

mentioning

confidence: 99%

Cerebral Lesions at Fetal Magnetic Resonance Imaging and Neurologic Outcome After Single Fetal Death in Monochorionic Twins

et al. 2015

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Background: Single fetal death (sFD) in monochorionic twin pregnancies is associated with substantial morbidity and mortality in the survivor. The aim of our study was to evaluate the rate of cerebral lesions detected at fetal Magnetic Resonance Imaging (MRI) and to correlate the results with the neurologic outcome of the survivors of monochorionic twin pregnancies after sFD. Methods: Between 2005 and 2012, 11 monochorionic twin pregnancies with sFD and subsequent fetal MRI of the survivor were included. All neonates underwent neurologic assessment after birth and 56% of surviving infants underwent long-term neurologic assessment. MRI findings and neurologic outcome of the survivors were evaluated. Results: Gestational age at sFD was 20.9 (±2.9) weeks; 55% (6/11) of survivors of monochorionic twin pregnancies after sFD showed cerebral lesions at fetal MRI; 72% (8/11) of all survivors had normal neonatal neurologic outcome: all survivors with normal fetal MRI and 50% of survivors with cerebral lesions at fetal MRI. Longterm neurologic assessment was normal in all tested patients with normal fetal MRI and in one of three tested patients with cerebral lesions at fetal MRI. Conclusion: Survivors of monochorionic twin pregnancies after sFD show a high rate of cerebral lesions at fetal MRI. The importance of cerebral lesions at fetal MRI in survivors after sFD in monochorionic twin pregnancies is uncertain. All tested survivors with normal fetal MRI showed normal neurologic outcome but only one of three survivors with cerebral lesions at fetal MRI showed normal long-term neurologic outcome.

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Persistance of adverse obstetric and neonatal outcomes in monochorionic twins after exclusion of disorders unique to monochorionic placentation

Cited by 56 publications

References 21 publications

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

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

Prospective risk of intrauterine death of monochorionic-diamniotic twins

Cerebral Lesions at Fetal Magnetic Resonance Imaging and Neurologic Outcome After Single Fetal Death in Monochorionic Twins

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