Perinatal outcome of monochorionic diamniotic twin pregnancies managed from early gestation at a single center

Nakayama, Sosogu; Ishii, Keisuke; Kawaguchi, Haruna; Hayashi, Satoru; Hidaka, Noriaki; Murakoshi, Takeshi; Mitsuda, Nobuaki

doi:10.1111/j.1447-0756.2011.01759.x

Cited by 36 publications

(47 citation statements)

References 39 publications

(103 reference statements)

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and seven on only dichorionic twin pregnancies 2833 35 46 52 55 58 Twenty three authors provided relevant unpublished data 16…”

Section: Resultsmentioning

confidence: 99%

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

Cheong-See

Schuit

Arroyo-Manzano

et al. 2016

BMJ

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Objective To determine the risks of stillbirth and neonatal complications by gestational age in uncomplicated monochorionic and dichorionic twin pregnancies.Design Systematic review and meta-analysis.Data sources Medline, Embase, and Cochrane databases (until December 2015). Review methods Databases were searched without language restrictions for studies of women with uncomplicated twin pregnancies that reported rates of stillbirth and neonatal outcomes at various gestational ages. Pregnancies with unclear chorionicity, monoamnionicity, and twin to twin transfusion syndrome were excluded. Meta-analyses of observational studies and cohorts nested within randomised studies were undertaken. Prospective risk of stillbirth was computed for each study at a given week of gestation and compared with the risk of neonatal death among deliveries in the same week. Gestational age specific differences in risk were estimated for stillbirths and neonatal deaths in monochorionic and dichorionic twin pregnancies after 34 weeks’ gestation.Results 32 studies (29 685 dichorionic, 5486 monochorionic pregnancies) were included. In dichorionic twin pregnancies beyond 34 weeks (15 studies, 17 830 pregnancies), the prospective weekly risk of stillbirths from expectant management and the risk of neonatal death from delivery were balanced at 37 weeks’ gestation (risk difference 1.2/1000, 95% confidence interval −1.3 to 3.6; I2=0%). Delay in delivery by a week (to 38 weeks) led to an additional 8.8 perinatal deaths per 1000 pregnancies (95% confidence interval 3.6 to 14.0/1000; I2=0%) compared with the previous week. In monochorionic pregnancies beyond 34 weeks (13 studies, 2149 pregnancies), there was a trend towards an increase in stillbirths compared with neonatal deaths after 36 weeks, with an additional 2.5 per 1000 perinatal deaths, which was not significant (−12.4 to 17.4/1000; I2=0%). The rates of neonatal morbidity showed a consistent reduction with increasing gestational age in monochorionic and dichorionic pregnancies, and admission to the neonatal intensive care unit was the commonest neonatal complication. The actual risk of stillbirth near term might be higher than reported estimates because of the policy of planned delivery in twin pregnancies.Conclusions To minimise perinatal deaths, in uncomplicated dichorionic twin pregnancies delivery should be considered at 37 weeks’ gestation; in monochorionic pregnancies delivery should be considered at 36 weeks.Systematic review registration PROSPERO CRD42014007538.

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Section: Resultsmentioning

confidence: 99%

“…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…”

Section: Resultsmentioning

confidence: 99%

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

Cheong-See

Schuit

Arroyo-Manzano

et al. 2016

BMJ

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180

150

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“…Approximately 2-6% of monochorionic twin pregnancies develop spontaneous TAPS [3,4]. The major cause is thought to be the shunting of blood from the donor to the recipient twin via miniscule chorionic AV anastomoses; this can result in severe anemia and hypoalbuminemia in the donor twin and polycythemia and thrombocytopenia in the recipient twin [5,6,7].…”

Section: Discussionmentioning

confidence: 99%

Therapy by Laser Equatorial Placental Dichorionization for Early-Onset Spontaneous Twin Anemia-Polycythemia Sequence

et al. 2013

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We report a case of twin anemia-polycythemia sequence (TAPS) treated by fetoscopic laser equatorial placental dichorionization, also known as the ‘Solomon technique', at 24 weeks of gestation. TAPS was present despite the absence of fetoscopically visualized chorionic anastomoses from the donor to the recipient twin. The goal of this procedure was to prevent post-laser TAPS in cases of twin-twin transfusion syndrome. The surgery and subsequent intrauterine blood transfusion to the donor twin could result in the survival of both twins without hematologic or neurological complications. Following the surgery, a placental injection test revealed no residual anastomoses. At present, laser therapy is not always feasible for TAPS, primarily because of its difficulty. However, laser therapy using the Solomon technique could be a viable approach for early-onset TAPS, especially in difficult situations in which undetectable vascular anastomoses related to TAPS are present.

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“…Approximately 10% of monochorionic twin pregnancies develop TTTS, which is associated with a poor perinatal outcome [2,3]. The major cause of this pathological condition is the shunting of blood from the donor twin to the recipient twin via placental vascular anastomoses, which may result in severe oligohydramnios developing in the donor twin and polyhydramnios and cardiac failure developing in the recipient twin.…”

Section: Discussionmentioning

confidence: 99%

Laser Therapy for Twin-Twin Transfusion Syndrome in the Absence of Fetoscopically Visible Placental Vascular Anastomoses

Ishii¹,

Taguchi²,

Yamamoto³

et al. 2013

Fetal Diagn Ther

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Fetoscopic laser photocoagulation (FLP) was performed at 22 weeks of gestation for a pregnancy complicated with twin-twin transfusion syndrome (TTTS) and an anterior placenta. However, vascular anastomoses could not be identified by the fetoscope. To dichotomize the circulation between the twins, the terminal ends of the paired artery and vein of the recipient twin were coagulated. In addition, a line was drawn with the laser connecting the dots, which had been coagulated. The Doppler waveform as well as the amniotic fluid volume of each twin normalized after the procedure. The twins were delivered by cesarean section subsequent to onset of labor at gestational week 30; the recipient twin weighed 1,350 g and the donor twin weighed 550 g. Both twins had a normal neurologic exam at 6 months of age. Patent placental vascular anastomoses could not be detected. This case demonstrates that vascular anastomoses in TTTS may not be identified by a fetoscope and that FLP to coagulate the entire vascular equator closer to the area of the recipient twin was effective in this rare situation.

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Perinatal outcome of monochorionic diamniotic twin pregnancies managed from early gestation at a single center

Abstract: The incidence of perinatal complications in 219 sets of MD twins managed from early gestational age to the neonatal period in one perinatal center was demonstrated. The incidence of TTTS was 8%; the survival rate was 89% at 28 days of age.

Cited by 36 publications

References 39 publications

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

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

Therapy by Laser Equatorial Placental Dichorionization for Early-Onset Spontaneous Twin Anemia-Polycythemia Sequence

Laser Therapy for Twin-Twin Transfusion Syndrome in the Absence of Fetoscopically Visible Placental Vascular Anastomoses

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