Good clinical practice advice: Management of twin pregnancy

Renzo, Gian Carlo Di; Fonseca, Eduardo Borges da; Gratacós, Eduard; Hassan, Sonia S.; Курцер, М. А.; Malone, Fergal D.; Nambiar, Shilpa; Nicolaides, Kypros; Sierra, Nancy; Yang, Huixia; Fuchtner, Carlos; Berghella, Vincenzo; Morales, Ernesto Castelazo; Hanson, Mark; Hod, Moshe; Ville, Y.; Visser, Gerard H.A.; Simpson, Joe Leigh; Adra, Abdallah; Bataeva, R.S.; Roura, Luis Cabero; Chmait, Ramen H.; Cheng, Yvonne W.; Hyett, Jon; Khalil, Asma; Malhotra, Narendra; Giardina, Irene; Nazareth, Amala; Poon, Chiu Yee Liona; Purandare, C. N.; Quintero, Rubén A.; Sepúlveda, Waldo; Tosto, Valentina

doi:10.1002/ijgo.12742

Cited by 33 publications

(60 citation statements)

References 48 publications

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“…In this view, it could constitute a physiologic adaptation intrinsic in twins that would support the use of twins-specific charts to avoid misdiagnoses and unnecessary interventions, as recommended by many Authors. 13,[37][38][39][40] Interestingly, our findings on Doppler references resemble the phenomenon observed for growth curves, with quantitative differences with singletons from the early second trimester that become more pronounced after 30 gestational weeks.…”

Section: Discussionsupporting

confidence: 81%

Cerebro‐placental and umbilico‐cerebral ratios in uncomplicated monochorionic twins: Longitudinal references and comparison with singletons

et al. 2022

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Objectives: Monochorionic twins (MC) are at high risk of adverse outcomes and Doppler investigation of umbilical and cerebral flows is mandatory for their surveillance. The cerebro-placental (CPR) and umbilico-cerebral (UCR) ratios are considered non-invasive measures of fetal adaptation to hypoxemia. We aimed to provide longitudinal references for CPR and UCR from 16 to 37 weeks of gestation that are specific for MC twins, and compare these with singleton charts.Methods: Longitudinal study of a cohort of consecutive uncomplicated MC twin pregnancies monitored at our unit from 2010 to 2018. The estimated centile curves were obtained estimating the median with fractional polynomials by a multilevel model and the external centiles through the residuals. The comparison with singletons references was made through graphic evaluation.Results: One-hundred-fifty-two MC pregnancies were included with a median of 10 longitudinal ultrasounds each. References for CPR and UCR in function of gestational age are presented. Compared to singletons, MC twins showed an earlier and greater circulatory redistribution with lower CPR and higher UCR median values.Conclusions: MC twin-specific references for CPR and UCR suitable for serial monitoring are presented. The comparison with singleton references demonstrates substantial differences in the hemodynamic balance that must be considered when interpreting findings in MC twins. Key pointsWhat's already known about this topic? � Uncomplicated monochorionic twins have higher umbilical flow and lower cerebral flow resistances compared to singletons, especially at increasing gestational ages. What does this study add?� Monochorionic twins-specific longitudinal references for cerebro-placental and umbilicocerebral ratios from 16 to 37 weeks are reported.� Compared to singletons, uncomplicated monochorionic twins exhibit earlier and greater centralization of blood flow.Twins congress live online congress, 4-6 June 2021.

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Section: Discussionsupporting

confidence: 81%

Cerebro‐placental and umbilico‐cerebral ratios in uncomplicated monochorionic twins: Longitudinal references and comparison with singletons

et al. 2022

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“…Seven recommendations across six CPGs detailed the appropriate methods to determine chorionicity which included the number of placental masses, membrane thickness and identifying the T or lamba sign (9,27,29,30,39,41,48). A total of 14 recommendations across 11 CPGs recommended procedures to maintain and document twin designation which covered nomenclature and description of twin fetuses, photographic records following chorionicity and the documentation strategy (9,28,49,29,32,(39)(40)(41)(42)(43)48).…”

Section: Chorionicity and Datingmentioning

confidence: 99%

“…In seven CPGs, 14 recommendations addressed the optimal timing for gestational age assessment and the method required for dating the pregnancy when the optimal timing for gestational age assessment had passed (9,28,29,32-34,39-41,48). One CPG stated dating is most accurate in the rst trimester and 2 further CPGs were more precise with speci ed CRL 45-84mm and between 11+0-13+6 weeks gestation, and another recommended dating from 7 weeks and beyond (9,29,33,48). There were ve con icting CPG recommendations regarding dating pregnancies following ART (9,29,32,33,40).…”

Section: Chorionicity and Datingmentioning

confidence: 99%

Clinical practice guidelines for the antenatal management of dichorionic diamniotic twin pregnancies: a systematic review

O’Connor

Leitão

et al. 2023

Preprint

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Objective: This review aimed to identify guidelines with recommendations applicable to the antenatal management of dichorionic diamniotic pregnancies within high-income countries, appraise their methodological quality, and discuss the similarities and variability across guidelines. Method: A systematic literature review of electronic databases was performed. Manual searches of guideline repositories and websites of professional organisations were performed to identify additional guidelines. The protocol for this systematic review was registered on PROSPERO(CRD42021248586, 25 June 2021). AGREE II and AGREE-REX tools were applied to assess the quality of eligible guidelines. A narrative and thematic synthesis described and compared the guidelines and their recommendations. Results: Twenty-four guidelines were included, from which 483 recommendations were identified across 4 international organisations and 12 countries. Guidelines addressed eight themes and recommendations were classified accordingly: chorionicity and dating (103 recommendations), fetal growth (105 recommendations), termination of pregnancy (12 recommendations), fetal death (13 recommendations), fetal anomalies (65 recommendations), antenatal care (65 recommendations), preterm labour (56 recommendations) and birth (54 recommendations). Guidelines showed significant variability in recommendations, with conflicting recommendations regarding non-invasive preterm testing, definitions surrounding selective fetal growth restriction, screening for preterm labour and the timing of birth. Guidelines lacked a focus on standard antenatal management of DCDA twins, management of discordant fetal anomaly and single fetal demise. Conclusions: Specific guidance for dichorionic diamniotic twins is overall indistinct and access to guidance regarding the antenatal management of these pregnancies is currently difficult. Management of discordant fetal anomaly or single fetal demise needs greater consideration.

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“…showed that expression of lectin and the mannose 6-phosphate receptor (which are important for angiogenesis and fetal growth) in the endoplasmic reticulum was increased significantly in the placenta of a selectively growth-restricted twin of a MC twin pair. Asma Khalil summarized the guidelines on management of a TP set by the International Federation of Gynecology and Obstetrics (FIGO) 7 …”

Section: Perinatal Mortality and Morbidity In A Multiple Pregnancymentioning

confidence: 99%

Highlights from the International Twins Congress 2021

Wang

Yang

2022

Maternal Fetal Med

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Good clinical practice advice: Management of twin pregnancy

Cited by 33 publications

References 48 publications

Cerebro‐placental and umbilico‐cerebral ratios in uncomplicated monochorionic twins: Longitudinal references and comparison with singletons

Cerebro‐placental and umbilico‐cerebral ratios in uncomplicated monochorionic twins: Longitudinal references and comparison with singletons

Clinical practice guidelines for the antenatal management of dichorionic diamniotic twin pregnancies: a systematic review

Highlights from the International Twins Congress 2021

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