Uncomplicated Monochorionic Diamniotic Twins and the Timing of Delivery

Cleary-Goldman, Jane; D’Alton, Mary E.

doi:10.1371/journal.pmed.0020180

Cited by 31 publications

(25 citation statements)

References 8 publications

(12 reference statements)

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“…12 One possible concession is to offer delivery of these apparently uncomplicated monochorionic twins at approximately 34 to 35 weeks of gestation after antenatal corticosteroid administration and appropriate counseling regarding the pros and cons of expectant management versus elective preterm delivery. 6 Based on our results and on recent observations regarding the excess risk of respiratory complications after near term twin delivery, 13,14 we believe that our policy of offering elective preterm birth after 36 completed weeks of gestation is a more reasonable compromise.…”

Section: Commentmentioning

confidence: 68%

“…Whereas the results of the study of Barigye et al 5 seem to suggest that 32 weeks of gestation may be a reasonable date for elective preterm delivery to avoid unexpected IUFDs, the inherent risks of prematurity at that gestational age remain significant. 6 In the absence of randomized studies, balancing the risk of elective preterm birth versus the risk of single or double IUFD is still challenging. 6 As a result, we carried out this retrospective cohort study to reassess the prospective risk of IUFD in our monochorionic twin population.…”

mentioning

confidence: 99%

“…6 In the absence of randomized studies, balancing the risk of elective preterm birth versus the risk of single or double IUFD is still challenging. 6 As a result, we carried out this retrospective cohort study to reassess the prospective risk of IUFD in our monochorionic twin population.…”

mentioning

confidence: 99%

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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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Section: Commentmentioning

confidence: 68%

mentioning

confidence: 99%

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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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“…However, even this subset of apparently " uncomplicated " MC twins was found to be at a considerable excess risk (about 4 % per pregnancy) of IUFD [2] . In their discussion of the unexpected IUFD rate among these MC twins, Cleary-Goldman and D ' Alton [5] suggested that elective preterm delivery (at 34 -35 weeks) might be a reasonable policy to avoid unexpected IUFD. Several other hospital-based studies found a much lower risk, but had an important disadvantage of coming from tertiary centers, some with special interest in MC twinning, which do not represent the population at large.…”

Section: Prophylaxismentioning

confidence: 99%

Single fetal death in twin gestations

Blickstein

Perlman

2012

Journal of Perinatal Medicine

103

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Twin pregnancies are at higher risk for fetal mortality when compared with singleton pregnancies. Single fetal demise occurs in 3.7 -6.8 % of all twin pregnancies and considerably increases the complication rate in the co-twin including fetal loss, premature delivery, and end-organ damage. In this review, we summarize the current information on the etiology of single twin demise, the pathophysiology of injury to the surviving twin, and the preventive and secondary management strategies.

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“…The incidence of perinatal complications is reportedly higher in pregnant women with monochorionic twins [3][4][5][6][7]. Chorionicity can be reliably determined in the first trimester of pregnancy by using non-invasive ultrasonography [8].…”

Section: Introductionmentioning

confidence: 99%