Contemporary management of monochorionic diamniotic twins: outcomes and delivery recommendations revisited

Smith, Nicole A.; Wilkins‐Haug, Louise; Santolaya-Forgas, Joaquín; Acker, David; Economy, Katherine E.; Benson, Carol B.; Robinson, Julian N.

doi:10.1016/j.ajog.2010.02.066

Cited by 41 publications

(37 citation statements)

References 19 publications

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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and seven on only dichorionic twin pregnancies 2833 35 46 52 55 58 Twenty three authors provided relevant unpublished data 16…”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%

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

Cheong-See

Schuit

Arroyo-Manzano

et al. 2016

BMJ

188

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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Section: Resultsmentioning

confidence: 99%

“…33 35 46 52 55 58 Twenty three authors provided relevant unpublished data 1628 30 32 33 34 35 38 39 41 42 43 47 48 49 50 51 52 53 54 56 57 58…”

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

188

150

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“…1,11,17 A STFF foi documentada em 11,1% das gestações MC, o que está de acordo com o reportado por outros centros. [10][11][12]16,17,22 À semelhança do que foi descrito por outro estudo português 1 , encontrou-se uma maior incidência de cesariana na gravidez MC.…”

Section: 13unclassified

“…4,16,17,22 No entanto, algumas séries mostram que mesmo as gestações MC não complicadas apresentam um risco de morte consideravelmente superior, 24,25 o que leva a crer que a história natural da gestação múltipla e, em particular, da MC não seja ainda completamente conhecida. 4,22 Este estudo destaca o impacto que a gemelaridade tem numa maternidade central a vários níveis: no número total de nascimentos, no âmbito dos RN muito baixo peso, na prematuridade e nas admissões em UCIN, o que vai ao encontro do que é descrito por outros autores. 2,3,11,12,22,26 Como limitações deste trabalho salientam-se a natureza retrospetiva da análise e a dimensão da amostra que, embora grande para o universo nacional, não permite nú-meros expressivos que possibilitem determinadas comparações entre os grupos, nomeadamente a incidência de morbilidade neurológica em função da corionicidade.…”

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Impacto da Corionicidade nas Complicações Perinatais da Gestação Gemelar

et al. 2017

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The incidence of multiple gestations is increasing worldwide and many studies have shown higher perinatal morbidity and mortality rates in monochorionic twins compared to dichorionic. The aim of this study was to assess the twin population born at a tertiary center and to evaluate the impact of chorionicity on perinatal outcomes of twin pregnancies. Material and Methods:Retrospective study of all twins born in a tertiary center from January 2004 to December 2013. Results: In this period, 1051 twins were born, related to 540 gestations (26.7% monochorionic; 73.3% dichorionic). There was no statistical significant difference between the groups concerning obstetric complications. The monochorionic group had a higher incidence of intrauterine growth restriction (20.5 vs 11.3%, p < 0.001), lower mean maternal age (29.9 vs 31.9 years, p < 0.001), lower mean gestational age (33.4 vs 34.3 weeks, p < 0.05) and lower mean birth weight (1943 vs 2147 g, p < 0.001). Monochorionic twins had a higher incidence of hyaline membrane disease (7 vs 4%, p < 0.05), sepsis (10.3 vs 5.8%, p < 0.05) and anemia (9.5 vs 5.4%, p < 0.05). There were no statistical significant differences concerning necrotizing enterocolitis, intraperiventricular hemorrhage or retinopathy of prematurity. Perinatal mortality was higher in the monochorionic group (5.2 vs 2.9%, p < 0.05). Discussion: Monochorionic twins represent considerable challenges to both obstetricians and neonatologists and should be monitored and delivered at tertiary centers. Conclusion: Currently gemelarity has a major impact on total births. It would be interesting to develop protocols to standardize clinical approach to twins.

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Current awareness in prenatal diagnosis

2010

Prenatal Diagnosis

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In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of prenatal diagnosis. Each bibliography is divided into 22 sections: 1 Reviews; 2 General Interest; 3 Normal Fetal Development; 4 Preimplantation Genetic Diagnosis; 5 First Trimester Diagnosis; 6 Second Trimester Diagnosis; 7 Fetal Imaging: General; Ultrasound; MRI; Doppler; 8 Maternal Serum Screening for Aneuploidy; 9 Screening for Carriers of Genetic Abnormality; 10 Molecular Cytogenetics: Metaphase Cytogenetics/FISH; Array CGH; 11 Fetal Cells in Maternal Circulation; 12 Fetal DNA/RNA in Maternal Body Fluids; 13 Fetal Therapy; 14 Psychosocial and Ethical Aspects; 15 Epidemiology and Environmental Factors; 16 Developmental and Placental Pathology; 17 Genetic Counseling. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted

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Contemporary management of monochorionic diamniotic twins: outcomes and delivery recommendations revisited

Cited by 41 publications

References 19 publications

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

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

Impacto da Corionicidade nas Complicações Perinatais da Gestação Gemelar

Current awareness in prenatal diagnosis

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