A higher prevalence has been reported in pregnancies complicated by selective growth restriction (sFGR), birth weight discordance (BWD). We aimed to investigate the association between cord insertion site and adverse pregnancy outcomes in twin pregnancies. Methods: A single-centre cohort study of twin pregnancies that had placental histology. Higher-order multiples, major fetal anomaly, aneuploidy and MCMA pregnancies were excluded. Cord insertion site was categorised into 3 groups: marginal (attachment <2cm to the placental margin), velamentous (attached to the membrane before reaching the placenta with vessels traversing the membranes), normal. Chorionicity, placental weight, number of cord vessels, examination of the membranes, ultrasound findings, maternal characteristics and pregnancy outcome were collected. Results: 546 pregnancies were eligible; 497 (146 monochorionic; 351 dichorionic) were included in the analysis. Significant differences were found between the normal and abnormal cord insertion groups with regards to BWD (P=0.001), BWD>25% (P=0.001), and absolute Z-score differences (P=0.020). Velamentous, but not marginal, cord insertion was significantly associated with sFGR (OR 8.51,95%CI 2.09-34.58;P=0.03) and BWD>25% (OR 11.88,P=0.04). In MCDA, but not DCDA pregnancies, the rate of composite adverse outcome was higher in those with abnormal cord insertion (70.0% vs 53.0%, p=0.04). Conclusions: Selective fetal growth restriction and birthweight discordance are more common in twin pregnancies with abnormal cord insertion. MCDA twins with velamentous cord insertion are at increased risk of sFGR, and composite adverse pregnancy outcome. P29.06Outcomes of monochorionic diamniotic twin pregnancies in tertiary fetal medicine centre with new access to invasive fetal therapy Centre of Fetal Medicine, Institute for the Care of Mother and Child, Prague, Czech RepublicObjectives: The aim of this study was to illustrate pregnancy outcomes of monochorionic diamniotic twin pregnancies in our institute -a tertiary fetal medicine centre with fetal therapy program since 2012. Methods: Observational retrospective cohort study describing 236 cases of monochorionic diamniotic twin pregnancies delivered in a single centre from 2012 to 2016. Results: From a total of 236 monochorionic twins that delivered in our institute, 207 (87.7%) resulted in two survivors, 27 (11.4%) in one survivor and 2 (0.8%) in no survivor. Overall mortality was 6.5%.12.4% of pregnancies delivered below 26 weeks of gestation, 9% at 26-28 weeks, 19.3% at 28-32 weeks and 44.6% were born at 32-36th weeks. Only 37 (14.7%) monochorionic twins had uncomplicated course with two live born fetuses delivered after 36 weeks.Out of 109 pregnancies after fetal surgery, we delivered 35 after Twin-twin transfusion syndrome (TTTS), 16 with severe discordant growth without TTTS and 9 with discordant congenital anomalies. Mortality after TTTS was 17%, which accounted for 12 of 31 (39%) losses. After 32 weeks of gestation 19 fetuses demised (4%). Conclusions: Mono...
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