The Effect of Chorionicity on Maternal Cardiac Adaptation to Uncomplicated Twin Pregnancy: A Prospective Longitudinal Study

Abstract

Objective: The objective of this study was to longitudinally evaluate maternal echocardiographic findings in uncomplicated twin gestations according to chorionicity. Methods: Healthy women with twin pregnancy were assessed with transthoracic echocardiography across the first, second, and third trimesters. Cardiac findings were compared within each group and between monochorionic (MC) and dicho­rionic (DC) pregnancies. Results: Overall, 19 MC and 48 DC uncomplicated twin pregnancies were included. In the MC group, no significant maternal haemodynamic changes were documented across gestation, with the exception of a decrease in ejection fraction. Compared to DC pregnancies, in the MC set lower cardiac output (second and third trimester, p = 0.001 and p = 0.006, respectively) and higher total vascular resistance (first trimester, p = 0.032) were observed. Regarding the diastolic function in MC twins, significantly higher values were observed for mitral E/A ratio (third trimester, p = 0.014), septal mitral E1/A1 ratio (third trimester, p = 0.030), lateral mitral E1 (second and third trimester, p = 0.014 and p = 0.029, respectively), and E1/A1 ratio (third trimester, p = 0.006). Conclusions: Maternal cardiac adaptation in twin pregnancy seems to differ significantly according to chorionicity. In particular, in MC pregnancies the impairment of diastolic function is less pronounced, presumably due to the lower circulating volume.

Morphofunctional Cardiac Changes in Singleton and Twin Pregnancies

“…Ghi et al reported that monochorionic twin pregnancies recognized lower CO, higher systemic vascular resistance, and higher E/A compared to dichorionic twin pregnancies [32], but we found no differences in echocardiographic parameters and cardiac biomarkers between the monochorionic and dichorionic twin pregnancies in our study ( Table 5). This result may also be associated with sample size issues, further investigation is warranted.…”

Maternal functional hemodynamics in uncomplicated twin pregnancies: A longitudinal study using impedance cardiography

“…In our study, chorionicity did not seem to affect any hemodynamic parameter. In another recent study using echocardiography, longitudinal changes in maternal hemodynamics were of smaller magnitude in monochorionic than in dichorionic twin pregnancies, 29 possibly because of a smaller increase in the circulating volume.…”

Morphofunctional cardiac changes in singleton and twin pregnancies: a longitudinal cohort study

“…However, this trend was not observed in women with twin pregnancies because of the limited sample size and because catecholamine production from postoperative pain affected BNP, considering that 95% of women had undergone cesarean section [34]. We found two reports of hemodynamic comparison between monochorionic and dichorionic twin pregnancies [18,35]. Ghi et al reported that monochorionic twin pregnancies had lower cardiac output, higher systemic vascular resistance, and higher E/A than dichorionic twin pregnancies [35], but our study found no differences in echocardiographic parameters and cardiac biomarkers between monochorionic and dichorionic twin pregnancies (Table 5), as in the results of Orland et al [18].…”

“…We found two reports of hemodynamic comparison between monochorionic and dichorionic twin pregnancies [18,35]. Ghi et al reported that monochorionic twin pregnancies had lower cardiac output, higher systemic vascular resistance, and higher E/A than dichorionic twin pregnancies [35], but our study found no differences in echocardiographic parameters and cardiac biomarkers between monochorionic and dichorionic twin pregnancies (Table 5), as in the results of Orland et al [18]. Ghi et al [35] attributed the difference to the lower circulating blood volume of the monochorionic twin pregnancies, compared with that of the dichorionic twin pregnancies, but our study had no data to complement their findings.…”