Perinatal mortality in twin pregnancies: a 3-year analysis in Seine Saint-Denis (France)

Chitrit, Yvon; Filidori, M.; Pons, Jean-Claude; Duyme, M.; Papiernik, E

doi:10.1016/s0301-2115(99)00037-8

Cited by 41 publications

(31 citation statements)

References 13 publications

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“…It was found to be high, ranging from 20 to 68 perinatal deaths per 1000 births, both in older and in more recent literature. 1,[25][26][27][28] We report a lower incidence of perinatal mortality in term MC twins (i.e. 7 per 1000 infants), but this is still three-fold higher than in term singletons 29 and term dichorionic twin pregnancies 1 and almost two-fold higher than after vaginal birth of the term fetus in breech presentation.…”

Section: Discussionmentioning

confidence: 99%

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

Hack

Derks

Elias

et al. 2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

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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.

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Section: Discussionmentioning

confidence: 99%

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

Hack

Derks

Elias

et al. 2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

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“…This method particularly enables a differentiation between a fetus sonographically assessed as too small and a deficiency in development of the infant due to a hemodynamically effective placental insufficiency, as proven by smaller studies with signal pregnancies [5][6][7][8]. In twin pregnancies, IUGR and hypertensive disorders of pregnancy occur 15-30% more often [9,10]; the perinatal mortality is increased to 78/1,000 [11]. 70% of the fetal deaths occur prior to the 30th week of gestation [12]; 80% of the intrauterine or perinatally deceased infants had a birth weight of !1,500 [13].…”

Section: Introductionmentioning

confidence: 99%

Correlation of Doppler Velocimetry Findings in Twin Pregnancies Including Course of Pregnancy and Fetal Outcome

Joern¹,

Rath²

2000

Fetal Diagn Ther

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Objective: Subject of the study was the significance of umbilical artery Doppler velocimetry findings for the further course of pregnancy and fetal outcome in cases of twin pregnancies. Methods: In 206 cases of twin pregnancy, the umbilical artery was examined using Doppler velocimetry in the median 9 days prior to delivery, and the result was correlated with the further course of pregnancy and fetal outcome. 174 pregnancies showed normal Doppler findings of the umbilical artery (group A), 32 twin pregnancies showed pathological Doppler findings of at least one twin (group B). The median of the maternal age and the parity between the groups were not different. Results: In group B (pathological Doppler findings), intrauterine growth retardation and pre-eclampsia occurred 5 times more often than in group A (normal Doppler findings). The total rate of cesarean sections was not different between the study populations; the rate of deliveries by cesarean section in group B was significantly increased by a factor of 2.4 due to a pathological CTG. The median birth weight and the gestational age at birth were significantly lower in group B (1,660 g; 35 weeks) as compared to group A (2,460 g; 37 weeks; p < 0.001). In group B, the rate of premature deliveries up to reaching the 34th week of gestation was 3.4 times higher; the rate of SGA newborns was 6.3 times higher. Perinatal mortality was increased by a factor of 1.5 in group B compared to group A. Conclusion: The Doppler velocimetry findings have considerable effects on the further course of a multiple pregnancy. In case of pathological Doppler findings, early hospitalization and close monitoring of the pregnancy should be performed. In cases of additional pathological findings (maternal illness, pathological Doppler findings of fetal blood vessels), termination of the pregnancy has to be considered.

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“…Multiple pregnancies are recognised to be at increased risk of adverse outcome with twin perinatal mortality being 3-to 7-fold higher compared with singleton pregnancies (Chitrit et al, 1999;Powers & Kiely, 1994). Monochorionic diamniotic (MCDA) pregnancies are at higher risk of pregnancy loss compared to dichorionic (DC) twins (Hack et al, 2008;Dias et al, 2010a).…”

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confidence: 99%

Pregnancy Outcome of Monochorionic Twins: Does Amnionicity Matter?

et al. 2011

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Objective: To compare the fetal loss rate of monochorionic (MC) twin pregnancies according to their amnionicity. Methods: A retrospective review of all MC pregnancy outcomes in a tertiary centre. Pregnancy outcomes were compared for monochorionic monoamniotic (MCMA) versus monochorionic diamniotic (MCDA) pregnancies. Results: 29 MCMA and 117 MCDA twin pregnancies were identified. The overall fetal loss rate was significantly higher in MCMA (23/52, 44.2%) compared to MCDA pregnancies (28/233, 12%, Chi squared = 30.03, p < .001). Kaplan-Meier analysis showed that fetal survival rate in MCDA twins were significantly higher than in MCMA twins (Log-rank Chi-squared = 27.9, p < .0005). Early pregnancy ultrasound identified the causes for these fetal losses in some MCMA twins. After exclusion of identifiable causes, the difference in fetal survival was not significant in the two groups (Log-rank chi-squared = 0.373, p = .54). Conclusion: The loss rate for MCMA twins is high and occurs mainly due to discordant congenital abnormality, conjoint twins or twin reversed arterial perfusion (TRAP) sequence. Although the fetal loss rate in MCDA is lower than in MCMA pregnancies, the majority of fetal loss in MCDA pregnancies cannot be predicted at the first scan at presentation. The data of this study questions the widespread policy of a difference in the scheduling of elective delivery for MCMA and MCDA twins.

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Perinatal mortality in twin pregnancies: a 3-year analysis in Seine Saint-Denis (France)

Cited by 41 publications

References 13 publications

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

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

Correlation of Doppler Velocimetry Findings in Twin Pregnancies Including Course of Pregnancy and Fetal Outcome

Pregnancy Outcome of Monochorionic Twins: Does Amnionicity Matter?

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