Controversies in the management of twin pregnancy

Khalil, Asma; Liu, Becky

doi:10.1002/uog.22181

Cited by 29 publications

(57 citation statements)

References 150 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It is uncommon after 26 weeks, and in some cases there might be an earlier onset but delayed diagnosis. The optimal management for these pregnancies is yet to be ascertained 33 …”

Section: Discussionmentioning

confidence: 99%

“…The optimal management for these pregnancies is yet to be ascertained. 33 The data on expectant management originate from old papers with few included cases, so evidence on this management is of very low quality. In more recent publications, [14][15][16][26][27][28] laser was part of the management of these pregnancies, although in several countries, laser is usually reserved for pregnancies between 16 and 26 weeks of gestation.…”

Section: Ta B L E 1 General Characteristics and Quality Assessment Of The Included Studiesmentioning

confidence: 99%

See 1 more Smart Citation

Perinatal outcomes of twin pregnancies complicated by late twin‐twin transfusion syndrome: A systematic review and meta‐analysis

Sileo

D’Antonio

Benlioğlu

et al. 2021

Acta Obstet Gynecol Scand

View full text Add to dashboard Cite

Introduction Untreated twin‐to‐twin transfusion syndrome (TTTS) is associated with a high risk of perinatal mortality and morbidity. Laser surgery is recommended before 26 weeks of gestation. However, the optimal management in case of late TTTS (occurring after 26 weeks of gestation) is yet to be established. Material and methods We conducted a systematic review and meta‐analysis to evaluate the outcomes of monochorionic‐diamniotic twin pregnancies complicated by late TTTS according to different management options (expectant, laser therapy, amnioreduction, or delivery). The primary outcome was mortality, including single and double intrauterine, neonatal, and perinatal death. Secondary outcomes were composite morbidity, neuromorbidity, respiratory distress syndrome, admission to neonatal intensive care unit, intact survival (ie, free from neurological complications), and preterm birth before <32 weeks of gestation. Outcomes were reviewed according to the management and reported for the overall population of twins and disease status (ie, donor and recipient separately). Random‐effect meta‐analyses of proportions were used to analyze the data. Results Nine studies including 796 twin pregnancies affected by TTTS were included. No randomized controlled trials were available for inclusion. TTTS occurred at ≥26 weeks of gestation in 8.7% (95% CI 6.9%‐10.9%; 67/769) of cases reporting TTTS at all gestations. Intrauterine death occurred in 17.7% (95% CI 4.9%‐36.2%) of pregnancies managed expectantly, 5.3% (95% CI 0.9%‐12.9%) of pregnancies treated with laser, and 0% (95% CI 0%‐9%) after amnioreduction. Neonatal death occurred in 42.5% (95% CI 17.5%‐69.7%) of pregnancies managed expectantly, in 2.8% (95% CI 0.3%‐7.7%) of cases treated with laser, and in 20.2% (95% CI 6%‐40%) after amnioreduction. Only one study (10 cases) reported data on immediate delivery after diagnosis with no perinatal deaths. Perinatal death incidence was 55.7% (95% CI 31.4%‐78.6%) in twin pregnancies managed expectantly, 5.6% (95% CI 0.5%‐15.3%) in those treated with laser, and 20.2% (95% CI 6%‐40%) in those after amnioreduction. Intact survival was reported in 44.4%, 96.4%, and 78% of fetuses managed expectantly, with laser or amnioreduction, respectively. Conclusions Evidence regarding perinatal mortality and morbidity in twin pregnancies complicated by late TTTS according to the different managements was of very low quality. Therefore further high‐quality research in this field is needed to elucidate the optimal management of these pregnancies.

show abstract

“…It is uncommon after 26 weeks, and in some cases there might be an earlier onset but delayed diagnosis. The optimal management for these pregnancies is yet to be ascertained 33 …”

Section: Discussionmentioning

confidence: 99%

Section: Ta B L E 1 General Characteristics and Quality Assessment Of The Included Studiesmentioning

confidence: 99%

Perinatal outcomes of twin pregnancies complicated by late twin‐twin transfusion syndrome: A systematic review and meta‐analysis

Sileo

D’Antonio

Benlioğlu

et al. 2021

Acta Obstet Gynecol Scand

View full text Add to dashboard Cite

show abstract

“…In general, 10% of sFGR patients subsequently develop TTTS 10 and two‐thirds of TTTS patients are complicated by concurrent sFGR 31 . Furthermore, the relationship between more clinically severe pictures of sFGR and development of TTTS has been described in observational studies 32,33 . Development of sFGR Type II or TTTS is associated with an increased risk of poor perinatal outcomes, where diagnosis of either clinical entity necessitates a change in clinical management (eg, increased surveillance, fetal therapy, and delivery).…”

Section: Methodsmentioning

confidence: 99%

Selective Fetal Growth Restriction Type III

Chmait

Monson

Korst

et al. 2021

J of Ultrasound Medicine

View full text Add to dashboard Cite

Objectives Per a recent expert definition, diagnosis of selective fetal growth restriction (sFGR) in monochorionic diamniotic twins is based on an estimated fetal weight (EFW) <3% as sole criterion and/or combinations of 4 contributory criteria (1 twin EFW <10%; 1 twin abdominal circumference <10%; EFW discordance ≥25%; and smaller twin umbilical artery [UA] pulsatility index >95th percentile). We assessed these criteria in sFGR Type III (intermittent absent or reversed end‐diastolic flow of the UA [iAREDF]) patients to test whether meeting the more stringent parameters of the consensus definition had worse outcomes, that is, progression to sFGR Type II (persistent AREDF) or twin‐twin transfusion syndrome; or secondarily, decreased dual survivorship. Methods This was a retrospective study of referred sFGR Type III patients (2006–2017). Patients were retrospectively categorized using consensus criteria for 2 comparisons: 1) EFW <3% versus remaining cohort; 2) EFW <3% or met all 4 contributory criteria versus remaining cohort. Results Forty‐eight patients were studied. Comparison 1: EFW <3% patients (58.3%) were not more likely to demonstrate disease progression (46.4% versus 65.0%, P = .2489) or worse dual survivorship (78.6% versus 85.0%, P = .7161). Comparison 2: EFW <3% or met all 4 contributory criteria (75.0%) patients were not more likely than the others to demonstrate progression (44.4% versus 83.3%, P = .0235) or worse dual survivorship (80.6% versus 83.3%, P = 1.0000). Conclusions In a referred cohort of sFGR Type III patients, there was no evidence that meeting more stringent parameters of the consensus definition was associated with disease progression or dual survivorship.

show abstract

“…It is certain that more studies on multiple pregnancy are warranted in order to reduce the rate of complications in mother and baby 35 . As demonstrated by the current study, maternal cardiovascular assessment can provide clinicians with important information.…”

Section: Research Implicationsmentioning

confidence: 99%

Maternal echocardiographic changes in twin pregnancies with and without pre‐eclampsia

Giorgione

Melchiorre

O’Driscoll

et al. 2022

Ultrasound in Obstet & Gyne

Self Cite

View full text Add to dashboard Cite

What are the novel findings of this work?This study demonstrates that cardiac changes in left ventricular mass and indices of diastolic function in normotensive twin pregnancy are comparable to those observed in singleton pregnancy complicated by hypertensive disorders of pregnancy (HDP). Cardiac maladaptation in twin pregnancy was amplified in the presence of HDP, typically accompanied by increased peripheral vascular resistance compared with normotensive twin pregnancy. What are the clinical implications of this work?The similarity of cardiac findings between singleton pregnancies with HDP and normotensive twin pregnancies demonstrates the burden that twin pregnancy places on the maternal cardiovascular system, which is exacerbated further in the presence of HDP. These findings should be considered when designing effective preventative strategies in these high-risk pregnancies.

show abstract

Controversies in the management of twin pregnancy

Cited by 29 publications

References 150 publications

Perinatal outcomes of twin pregnancies complicated by late twin‐twin transfusion syndrome: A systematic review and meta‐analysis

Perinatal outcomes of twin pregnancies complicated by late twin‐twin transfusion syndrome: A systematic review and meta‐analysis

Selective Fetal Growth Restriction Type III

Maternal echocardiographic changes in twin pregnancies with and without pre‐eclampsia

Contact Info

Product

Resources

About