Perinatal outcome of monochorionic and dichorionic twins after spontaneous and assisted conception: a retrospective cohort study

Abstract

IntroductionThe aim of this study was to compare pregnancy outcomes in twin pregnancies after assisted conception and spontaneous conception, according to chorionicity.Material and methodsRetrospective cohort study of 1305 twin pregnancies between 1995 and 2015. All spontaneous (n = 731) and assisted conception conceived (n = 574) twin pregnancies with antenatal care and delivery in University Medical Center Utrecht, the Netherlands, a tertiary obstetric care center were studied according to chorionicity.ResultsMaternal age and incidence of nulliparity were higher among the assisted conception twins. Hypertensive disorders also appeared to be more frequent in assisted conception pregnancies, which could largely be explained by the higher proportion of elderly nulliparous women in this group. Spontaneously conceived twins were born earlier than twins after assisted conception, with subsequent lower birthweights and more admissions to a neonatal intensive care unit with increased neonatal morbidity. Monochorionic twins had worse pregnancy outcomes compared with dichorionic twins, irrespective of mode of conception; monochorionic twins conceived by assisted reproduction had more neonatal morbidity (mainly respiratory distress syndrome and necrotizing enterocolitis) and late neonatal deaths compared with spontaneously conceived monochorionic twins.ConclusionsSpontaneously conceived twins have worse pregnancy outcome compared with twins after assisted conception, probably due to a lower incidence of monochorionicity in the assisted conception group. The already increased perinatal risks in monochorionic twins are even higher in monochorionic twins conceived after infertility treatments compared with spontaneously conceived monochorionic twins, which warrants extra attention to these high‐risk pregnancies.

The maternal and perinatal implications of hypertensive disorders of pregnancy in a multiple pregnancy cohort

“…The higher incidence of HDP in our cohort in those conceiving through ovulation induction needs to be interpreted with caution as the numbers are small (n = 22) and when adjusted the confidence interval is very large. We did observe significantly more HDP when conception arose through use of a donor oocyte, which is well described by other studies in both singletons and multiples . It is worth noting that mode of conception in our cohort is self‐reported by women at their booking visit and hence may indeed be under reported.…”

“…We did observe significantly more HDP when conception arose through use of a donor oocyte, which is well described by other studies in both singletons and multiples. 30,31 It is worth noting that mode of conception in our cohort is self-reported by women at their booking visit and hence may indeed be under reported. The high rate of twins proves that the Irish ART sector needs regulation and protocols aimed at minimizing the risk of multiple pregnancy should be advocated.…”

Twin pregnancies concieved by assisted reproduction - early prediction of preterm birth

“…Adverse obstetric outcome after ART might be caused by the very procedure 4 . Moreover, ART conceived twins can be at even higher risk of pregnancy complications and adverse obstetric outcomes due to maternal age, pre-existing maternal medical conditions such as polycystic ovary syndrome or thyroid diseases that are associated with miscarriages and aneuploidies [7][8][9] .…”

Selective fetal termination in monochorionic twin pregnancies - pregnancy outcome after bipolar cord coagulation and interstitial laser coagulation

“…About one half of those pregnancies are uneventful, but the other half may be complicated by twin-totwin transfusion syndrome (TTTS), selective fetal growth restriction (sFGR), twin reversed arterial perfusion (TRAP) sequence or discordance for fetal abnormality (DFA). In the most severe forms of those complications, when one fetus is severely anomalous, or is suffering severe distress, particularly if the condition is compromising the non-affected fetus, selective fetal termination (SFT) may be the best option, as in the case of single intrauterine death of one fetus, profound consequences for the surviving twin are reported, including a 15-25% risk of death or neurological damage [1][2][3][4].…”

“…SFT in MC pregnancies is difficult because conventional feticide techniques with intracardiac injection of potassium chloride are not an option, as the substance could embolize to the non-affected twin through the placental vascular anastomoses [1,2,5]. Complete separation of the twin's blood flow is the only option for successful SFT.…”