Prospective risk of fetal death in uncomplicated monochorionic twins

Farah, Nadine; Hogan, Jennifer; Johnson, S.J.; Stuart, Bernard; Daly, Seán

doi:10.1111/j.1600-0412.2011.01288.x

Cited by 17 publications

(14 citation statements)

References 13 publications

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“…Next, caution is required in interpreting the late third-trimester findings in view of the declining numbers with advancing gestation; there were only 195 continuing pregnancies at 38 weeks of gestation from nine included studies, three of which offered no data beyond 36 weeks of gestation. All fetal deaths at 38-39 weeks of gestation occurred in one study, 23 all of which were unexplained in pregnancies undergoing ultrasonograms every 2 weeks with a local policy of delivery at 38-40 weeks of gestation. Because most centers deliver routinely before 38 weeks of gestation, have low thresholds for delivery after 34 weeks of gestation, or both, assessing rates of stillbirth in a sizeable population at this gestation is problematic.…”

Section: Resultsmentioning

confidence: 97%

“…Thus, nine studies were included in the systematic review, reporting outcomes from 1,747 monochorionicdiamniotic pregnancies. 5,[9][10][11][12]15,[21][22][23] Figure 1 shows the flow process for included studies with seven from Europe and two from the United States. Four included a dichorionic control group.…”

Section: Resultsmentioning

confidence: 99%

“…Two studies gave no details of their Doppler protocol, 9,12 whereas two others failed to mention whether Doppler studies were performed. 11,23 The quality of the selected studies based on the STROBE guidelines 19 is detailed in Appendix 1, available online at http://links.lww.com/AOG/A385. Generally, the selected studies were of good quality.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Increased Stillbirth in Uncomplicated Monochorionic Twin Pregnancies

Danon

Sekar

Hack

et al. 2013

Obstetrics &Amp; Gynecology

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Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Increased Stillbirth in Uncomplicated Monochorionic Twin Pregnancies

Danon

Sekar

Hack

et al. 2013

Obstetrics &Amp; Gynecology

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“…28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 Eighteen studies provided data on both monochorionic and dichorionic,16 30 32 34 36 38 40 42 43 44 45 48 49 50 51 54 56 57 seven on only monochorionic,29 31 37 39 41 47 53 and seven on only dichorionic twin pregnancies 2833 35 46 52 55 58 Twenty three authors provided relevant unpublished data 16…”

Section: Resultsmentioning

confidence: 99%

Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis

Cheong-See

Schuit

Arroyo-Manzano

et al. 2016

BMJ

194

150

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Objective To determine the risks of stillbirth and neonatal complications by gestational age in uncomplicated monochorionic and dichorionic twin pregnancies.Design Systematic review and meta-analysis.Data sources Medline, Embase, and Cochrane databases (until December 2015). Review methods Databases were searched without language restrictions for studies of women with uncomplicated twin pregnancies that reported rates of stillbirth and neonatal outcomes at various gestational ages. Pregnancies with unclear chorionicity, monoamnionicity, and twin to twin transfusion syndrome were excluded. Meta-analyses of observational studies and cohorts nested within randomised studies were undertaken. Prospective risk of stillbirth was computed for each study at a given week of gestation and compared with the risk of neonatal death among deliveries in the same week. Gestational age specific differences in risk were estimated for stillbirths and neonatal deaths in monochorionic and dichorionic twin pregnancies after 34 weeks’ gestation.Results 32 studies (29 685 dichorionic, 5486 monochorionic pregnancies) were included. In dichorionic twin pregnancies beyond 34 weeks (15 studies, 17 830 pregnancies), the prospective weekly risk of stillbirths from expectant management and the risk of neonatal death from delivery were balanced at 37 weeks’ gestation (risk difference 1.2/1000, 95% confidence interval −1.3 to 3.6; I2=0%). Delay in delivery by a week (to 38 weeks) led to an additional 8.8 perinatal deaths per 1000 pregnancies (95% confidence interval 3.6 to 14.0/1000; I2=0%) compared with the previous week. In monochorionic pregnancies beyond 34 weeks (13 studies, 2149 pregnancies), there was a trend towards an increase in stillbirths compared with neonatal deaths after 36 weeks, with an additional 2.5 per 1000 perinatal deaths, which was not significant (−12.4 to 17.4/1000; I2=0%). The rates of neonatal morbidity showed a consistent reduction with increasing gestational age in monochorionic and dichorionic pregnancies, and admission to the neonatal intensive care unit was the commonest neonatal complication. The actual risk of stillbirth near term might be higher than reported estimates because of the policy of planned delivery in twin pregnancies.Conclusions To minimise perinatal deaths, in uncomplicated dichorionic twin pregnancies delivery should be considered at 37 weeks’ gestation; in monochorionic pregnancies delivery should be considered at 36 weeks.Systematic review registration PROSPERO CRD42014007538.

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“…The median (range) of gestation in patients with a UCC diagnosis was 24 for Group A and 27 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) for Group B. The median (range) of gestation in patients with PCC diagnosis was 18 (16-33) weeks for Group A and 18 [16][17][18][19][20][21][22][23][24][25] weeks for Group B. The time of diagnosis of UCC (P = 0.568) and PCC (P = 0.584) was not significantly different in Groups A and B (Table 2).…”

Section: Resultsmentioning

confidence: 99%

The incidence of unexpected critical complications in monochorionic diamniotic twin pregnancies according to the interval period between ultrasonographic evaluations

Kawaguchi

Ishii

Muto

et al. 2018

J of Obstet and Gynaecol

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Aim: This study aimed to evaluate the incidence of unexpected critical complications (UCC) in monochorionic diamniotic (MCDA) twin pregnancies according to ultrasonographic scan interval. Methods: This retrospective single-center cohort study, conducted between January 2005 and April 2015, investigated the incidence of UCC in patients with MCDA twin pregnancies undergoing weekly ultrasound (Group A) and those undergoing biweekly ultrasound (Group B). We also examined the incidence of predictable critical complications according to ultrasound interval. Results: Of all 385 cases, the total incidence of UCC was 20 (5.2%), including 14 cases of twin-twin transfusion syndrome and 6 cases of intrauterine fetal death. The incidence of UCC was 3.9% in Group A and 9.0% in Group B (P = 0.046). In contrast, the incidence of predictable critical complications was 6.7% in Group A and 9.0% in Group B (P = 0.440). Conclusion: The incidence of UCC in patients with MCDA twin pregnancies was significantly lower in patients undergoing weekly ultrasound. Our results suggest that weekly ultrasound evaluation for patients with MCDA pregnancy is more effective for early detection of UCC such as intrauterine fetal death and twin-twin transfusion syndrome ; however, further investigations are needed to determine whether weekly ultrasound evaluation can improve clinical outcomes.

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Prospective risk of fetal death in uncomplicated monochorionic twins

Cited by 17 publications

References 13 publications

Increased Stillbirth in Uncomplicated Monochorionic Twin Pregnancies

Increased Stillbirth in Uncomplicated Monochorionic Twin Pregnancies

Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis

The incidence of unexpected critical complications in monochorionic diamniotic twin pregnancies according to the interval period between ultrasonographic evaluations

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