Patient-Reported Monochorionic-Diamniotic Twin Pregnancy Management and Experiences During the COVID-19 Pandemic: A Mixed-Methods Cross-Sectional Survey

Abstract

Monochorionic-diamniotic (MCDA) pregnancies are high-risk necessitating ongoing screening for serious complications and quick decision-making. COVID-19 pandemic protocols introduced unique challenges to pregnancy management and patient experience. In late 2021, an online, mixed-methods, cross-sectional survey recruited 561 participants who experienced an MCDA pregnancy within five years. Analyses included descriptive and bivariate statistics and thematic analysis. Findings suggest the pandemic did not negatively affect screening/diagnosis for these participants. Care consistent with guidelines was received by most, with care slightly better during the pandemic. Almost 80% (79.0%) received an MCDA diagnosis by gestational week 14 before the pandemic, 87.8% during. Most received biweekly ultrasounds, 88.0% prior to the pandemic, 88.9% during. Experiences were affected in other ways for almost 44% of participants pregnant during COVID-19; in ways likely shared by other high-risk pregnancies. Thematic analysis revealed management during COVID-19 impacted self-advocacy and emotions (eg, alienation, anxiety), made care seem impersonal, and resulted in delayed or canceled appointments. Policies should be considered, so future healthcare disruptions do not impact patients and preserve in-person health care with access to a support person.

Reduction in Spontaneous and Iatrogenic Preterm Births in Twin Pregnancies During COVID-19 Lockdown in Melbourne, Australia: A Multicenter Cohort Study

“…Some respondents felt their care was better, as high-risk pregnancies were prioritized during a time of resource rationing, corroborated by 4.7% more double MCDA twin survivors compared to the pre-pandemic period (p=0.04). 32 Although we were unable to analyze our results by chorionicity, our subgroup analysis supports these survey results as we did not detect higher rates of all-cause stillbirths among sex-concordant twins compared with sex-discordant twins. However, the lower number of twin pregnancies in exposure 1 may reflect reduced access to fertility services, due to the Victorian Government implementing restrictions on elective surgery including in-vitro fertilization from March 2020 with 85% of pre-COVID activity resumed in September 2020.…”

Reduction in spontaneous and iatrogenic preterm births in twin pregnancies during COVID-19 lockdown in Melbourne, Australia: a multicenter cohort study

“…However, an international survey of 561 women with MCDA pregnancies, including Australian women, showed most women’s care adhered to established guidelines during the pandemic. Some respondents felt their care was better , as high-risk pregnancies were prioritized during a time of resource rationing, corroborated by 4.7% more double MCDA twin survivors compared to the pre-pandemic period ( p = 0.04) [ 32 ]. Although we were unable to analyze our results by chorionicity, our subgroup analysis supports these survey results as we did not detect higher rates of all-cause stillbirths among sex-concordant twins compared with sex-discordant twins.…”