Perinatal mortality and mode of delivery in monochorionic diamniotic twin pregnancies ≥32 weeks of gestation: a multicentre retrospective cohort study

Abstract

Objective To study perinatal mortality rates in a cohort of 465 monochorionic (MC) twins without twin-twin transfusion syndrome (TTS) born at 32 weeks of gestation or later since reported interauterine fetal death (IUFD) rates >32 weeks of gestations in the literature vary, leading to varying recommendations on the optimal timing of delivery, and to investigate the relation between perinatal mortality and mode of delivery.Design Multicentre retrospective cohort study.Setting Ten perinatal referral centres in the Netherlands.Population All MC twin pregnancies without TTTS delivered at ‡32 weeks of gestation between January 2000 and December 2005.Methods The medical records of all MC twin pregnancies without TTTS delivered at the ten perinatal referral centres in the Netherlands between January 2000 and December 2005 were reviewed.Main outcome measures Perinatal mortality in relation to gestational age and mode of delivery at ‡32 weeks of gestation.Results After 32 weeks of gestation, five out of 930 fetuses died in utero and there were six neonatal deaths (6 per 1000 infants).In women who delivered ‡37 weeks, perinatal mortality was 7 per 1000 infants. Trial of labour was attempted in 376 women and was successful in 77%. There were three deaths in deliveries with a trial of labour (8 per 1000 deliveries), of which two were related to mode of delivery. Infants born by caesarean section without labour had an increased risk of neonatal morbidity and respiratory distress syndrome.Conclusions In MC twin pregnancies the incidence of intrauterine fetal death is low ‡32 weeks of gestation. Therefore, planned preterm delivery before 36 weeks does not seem to be justified. The risk of intrapartum death is also low, at least in tertiary centres.

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

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and seven on only dichorionic twin pregnancies 2833 35 46 52 55 58 Twenty three authors provided relevant unpublished data 16…”

“…33 35 46 52 55 58 Twenty three authors provided relevant unpublished data 1628 30 32 33 34 35 38 39 41 42 43 47 48 49 50 51 52 53 54 56 57 58…”

“…Primary studies,15 16 29 39 62 systematic reviews,13 and guideline bodies9 63 have been limited in their interpretation of evidence on the timing of delivery in twin pregnancies because of paucity of data and inadequate methods. Firstly, they compared the risks of stillbirth in twin pregnancies at various gestational weeks with those at, or near, term, without considering the inherent longitudinal design with women repeatedly observed during the pregnancy 64.…”

Polish Gynecological Society Recommendations for Labor Induction

“…Failures to a large extent are associated with the presence of a single chorion [30]. In monochorionic diamniotic pregnancies, hemodynamic abnormalities related to vascular connections in the placenta are associated with a significantly higher risk of mortality and morbidity of twins compared to dichorionic pregnancies [31]. In monochorionic monoamniotic pregnancies, umbilical cord looping and umbilical cord collision may lead to intrauterine asphyxia during labor [32].…”

Perinatal Mortality in Multiple Pregnancy

“…A large cohort of monochorionic twin pregnancies without TTTS reported a risk of fetal death after 32 weeks of 5 in 1000 births and an incidence of perinatal mortality in term monochorionic twins of 7 per 1000 infants (Hack et al, 2011). This is three-fold higher than in term singletons and term dichorionic twin pregnancies.…”