Monochorionic Diamniotic Twin Pregnancies: Natural History and Risk Stratification

Lewi, Liesbeth; Gucciardo, Léonardo; Mieghem, Tim Van; Koninck, Philippe de; Beck, Veronika; Medek, Helga; Schoubroeck, Dominique Van; Devlieger, Roland; Catte, Luc De; Deprest, Jan

doi:10.1159/000313300

Cited by 173 publications

(159 citation statements)

References 78 publications

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“…This seems to be due to an increase in the age of reproduction, the use of ovulation induction (OI) and the use of assisted reproduction techniques such in vitro fertilization (IVF) and intracytoplasmatic sperm injection (ICSI). It is well-known that maternal and obstetrical complications are more frequent in twin pregnancies than in singleton's [1][2][3][4][5][6]. However, there is no specific information regarding the pregnancy outcomes according to the place/protocols of surveillance.…”

Section: Introductionmentioning

confidence: 99%

Twins prematurity – the influence of prenatal surveillance

Domingues

Fonseca

Belo

et al. 2014

The Journal of Maternal-Fetal & Neonatal Medicine

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Objective: To evaluate the influence of the local prenatal surveillance of twin pregnancies in the obstetrical results. Methods: A prospective cohort study of multiple pregnancies delivered over a period of 16 years in a tertiary centre was conducted. In this study 861 twin pregnancies were included. They were compared for obstetric complications, gestational age at delivery, mode of delivery and birthweight, according to the place of the surveillance. Results: Of the 861 cases examined, the following obstetric complications were significantly different: metrorrhagia (p ¼ 0.039), infections (p50.001), HELLP (p ¼ 0.007), PROMPT (p50.001) and fetal death (p ¼ 0.024). The mode of delivery was similar but occurred mostly 32 weeks (p50.001), the birthweight was mostly 52000 g and occurred more NICU admission (p50.001) when surveillance was outside the MPC-MDM. Conclusion: Our results demonstrate the crucial importance of prenatal surveillance be carried in a differentiated referral centers with specific/strict protocols or the urgent implementation of same protocols in all other places of surveillance, since this straight surveillance greatly reduces the occurrence of prenatal complications, mainly PROMPT, PTD.

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Section: Introductionmentioning

confidence: 99%

Twins prematurity – the influence of prenatal surveillance

Domingues

Fonseca

Belo

et al. 2014

The Journal of Maternal-Fetal & Neonatal Medicine

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“…1,2 Despite the recent advances in perinatal management, TTTS is an important cause of neonatal death and handicap in infants. 2 TTTS is thought to arise from an imbalance of intertwin transfusion across vascular anastomoses in placentas, and leads to hypervolemia, polyuria and polyhydramnios in the recipient, and hypovolemia, oliguria and oligohydramnios in the donor. 2 However, although most of the placentas in MD twins have vascular anastomoses, approximately 85% of MD twins do not develop TTTS.…”

Section: Introductionmentioning

confidence: 99%

“…2 TTTS is thought to arise from an imbalance of intertwin transfusion across vascular anastomoses in placentas, and leads to hypervolemia, polyuria and polyhydramnios in the recipient, and hypovolemia, oliguria and oligohydramnios in the donor. 2 However, although most of the placentas in MD twins have vascular anastomoses, approximately 85% of MD twins do not develop TTTS. Furthermore, most TTTS patients do not have significant intertwin hemoglobin discordance.…”

Section: Introductionmentioning

confidence: 99%

“…However, there are no studies regarding the RAA and NP systems in MD twins without TTTS. The purposes of this study were (1) to assess cord blood levels of renin, aldosterone, hANP and BNP in dichorionic diamniotic (DD) and MD twins that do not satisfy the criteria of TTTS, (2) to compare these hormone levels between smaller and larger MD twins, (3) to compare these hormone levels between small and large BW discordance in non-TTTS MD twins and finally, (4) to investigate correlations between cord blood levels of renin, and BW discordance in non-TTTS MD and DD twins.…”

Section: Introductionmentioning

confidence: 99%

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Renin is activated in monochorionic diamniotic twins with birthweight discordance who do not have twin-to-twin transfusion syndrome

et al. 2011

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Objective: To assess renin, aldosterone, human atrial natriuretic peptide (hANP) and brain natriuretic peptide (BNP) levels in cord blood from monochorionic diamniotic (MD) twins with a birthweight (BW) discordance that do not satisfy the criteria of twin-to-twin transfusion syndrome (TTTS).Study Design: Cord blood samples were obtained from 28 MD twins without TTTS. They were divided into two groups on the basis of BW discordance as follows: large (>7.5%) and small (p7.5%). Cord blood renin, aldosterone, hANP and BNP levels were measured.Result: Renin levels in MD twins with a large BW discordance were significantly higher than those in MD twins with a small BW discordance, with no significant differences in aldosterone, hANP and BNP levels. A significant correlation was found between renin levels and BW discordance. Conclusion:Renin is activated in MD twins with a BW discordance of >7.5%, even in non-TTTS.

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“…A recent prospective study by two centers in Belgium as part of the Eurotwin2twin project noted this risk to be higher in monochorionic (MC) twins (7.5%) compared to dichorionic (DC) twins (3%; Lewi et al, 2010). MC pregnancies are at particular risk due to inter-twin placental vascular connections.…”

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confidence: 99%

Fetal Brain Injury in Survivors of Twin Pregnancies Complicated by Demise of One Twin: A Review

2016

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Perinatal mortality is increased considerably in multiple pregnancies compared to singleton pregnancies, with single intrauterine fetal demise (sIUFD) presenting a rare but unique perinatal problem. Monochorionic pregnancies are at particular risk of sIUFD due to bidirectional inter-twin placental vascular anastomoses. The resulting inter-twin blood flow can become unbalanced, causing acute and chronic inter-twin transfusion and profound anemia secondary to fetal exsanguination into the low-pressure circulation of the dead fetus. If the sIUFD occurs after 14 weeks' gestation it is believed to have the most significant effect on the continuing pregnancy as the co-twin is at increased risk of preterm delivery, long-term neurological complications, and death. This article will focus on fetal brain injury in the surviving co-twin in the case of sIUFD, as it is the most common kind of injury in sIUFD, and one which concerns parents and may be the basis for terminating the pregnancy. We will outline how these brain injuries are thought to occur and describe potential pathophysiological mechanisms. We will discuss risk factors for brain injury in cases of sIUFD, including: chorionicity, cause of the sIUFD (spontaneous or secondary to an underlying pathological process such as twin-to-twin transfusion syndrome), gestation of delivery and how to prevent brain injury in the co-twin. We also review modes of imaging, discuss the difficulties in predicting the long-term outcome for co-twin survivors, and highlight the dearth of research in this area.

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Monochorionic Diamniotic Twin Pregnancies: Natural History and Risk Stratification

Cited by 173 publications

References 78 publications

Twins prematurity – the influence of prenatal surveillance

Twins prematurity – the influence of prenatal surveillance

Renin is activated in monochorionic diamniotic twins with birthweight discordance who do not have twin-to-twin transfusion syndrome

Fetal Brain Injury in Survivors of Twin Pregnancies Complicated by Demise of One Twin: A Review

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