Twin chorionicity and the risk of adverse perinatal outcome

Acosta-Rojas, Ruthy; Becker, Jorge; Muñoz‐Abellana, B.; Ruiz, Carme Molinero; Carreras, Elena; Gratacós, Eduard

doi:10.1016/j.ijgo.2006.11.002

Cited by 185 publications

(169 citation statements)

References 23 publications

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“…Glinianaia et al [12] also reported that MC twins have higher SRs compared with MZ Di Chorionic (DC) twins in England during the period 1998-2007. Increased stillbirth risk in MC compared with DC twins are mainly attributed to twin-twin transfusion syndrome (TTTS) [13][14][15][16]. According to Morikawa et al [17], Japanese women with MC diamniotic twins were 2.2-fold more likely to experience stillbirth than women with DC diamniotic twins during the period [2005][2006][2007][2008].In the present study, 14% of FDs in MZ twins were attributable to TTTS.…”

Section: Discussionmentioning

confidence: 58%

Stillbirth Rates and Risk Factors for Stillbirths among Zygotic Twins in Japan, 1995-2008

Hayakawa¹

2014

J Neonatal Biol

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Section: Discussionmentioning

confidence: 58%

Stillbirth Rates and Risk Factors for Stillbirths among Zygotic Twins in Japan, 1995-2008

Hayakawa¹

2014

J Neonatal Biol

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“…An MC pregnancy with sIUGR was defined as a combination of the co-twin with an estimated fetal weight below the 10th percentile and fetal weight discordance between the twin pair >25% (Acosta-Rojas et al, 2007;Ananth et al, 1998). Intermittent UA-AEDF is not recognized as abnormal Doppler in this study.…”

Section: Methodsmentioning

confidence: 99%

“…But the etiology of betamethasoneinduced return of positive end-diastolic UA flow is unclear (Robertson et al, 2009). Selective intrauterine growth restriction (sIUGR) occurs in about 12% of monochorionic twin (MC) pregnancies (Gaziano et al, 2000;Gratacos et al, 2004;Sebire et al, 1997); MC twins have a higher incidence of respiratory and neurological complications than their dichorionic counterparts (Acosta-Rojas et al, 2007;Fick et al, 2006;Gonzalez-Quintero et al, 2003). Antenatal corticosteroids are often administered to enhance fetal lung maturity due to the frequent need for delivery earlier than 34 weeks of gestation in order to avoid the intrauterine fetal demise of the sIUGR twin, which could subsequently lead to brain injury of the co-twin arising from agonal transfusion (Russell et al, 2007).…”

mentioning

confidence: 99%

Placenta Share Discordance and Umbilical Artery Doppler Change After Antenatal Betamethasone Administration in Monochorionic Twins With Selective Intrauterine Growth Restriction: Is There a Link?

Chang

Chao

et al. 2012

Twin Res Hum Genet

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This study was designed to evaluate the degree of placenta share discordance in relation to the betamethasone-induced return of positive end-diastolic flow in monochorionic twin pregnancies with selective intrauterine growth restriction (sIUGR) and abnormal umbilical artery Doppler. Monochorionic twins with sIUGR was defined as one twin having an estimated fetal weight below the 10th percentile combined with an estimated fetal weight discordance >25%. The umbilical artery Doppler directly prior to (D0) and 24 hours (D1) and 48 hours (D2) after the first dose of betamethasone administration was recorded. The estimated individual placental weight in monochorionic twins was obtained by cutting the placenta along the vascular equator into two territories; the placenta share discordance was calculated as [(estimated individual placental weight of appropriated for gestational age twin-estimated individual placental weight of growth restricted twin)/estimated individual placental weight of appropriated for gestational age twin] × 100%. Six (23.1%) of the 26 included cases achieved betamethasone-induced return of positive umbilical artery end-diastolic flow. The difference of placenta share discordance and birth weight discordance were not significantly different between twins with and without betamethasone-induced return of positive umbilical artery end-diastolic flow. Thus, according to our study results, it was proposed that although the placenta share discordance correlated with the abnormal umbilical artery Doppler in the IUGR fetus in monochorionic twin, the betamethasone-induced return of positive umbilical artery end-diastolic flow, however, did not reveal the similar relationship with the severity of placenta share discordance.

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“…1,11,17 A STFF foi documentada em 11,1% das gestações MC, o que está de acordo com o reportado por outros centros. [10][11][12]16,17,22 À semelhança do que foi descrito por outro estudo português 1 , encontrou-se uma maior incidência de cesariana na gravidez MC.…”

Section: 13unclassified

“…1,2,[6][7][8]13 Vários estudos têm demonstrado taxas de morbilidade e mortalidade mais elevadas nos gé-meos monocoriónicos comparativamente com os bicorióni-cos. 1,4,9,16 Isto pode ser explicado pela ocorrência frequente de anastomoses vasculares entre os fetos e de inserção anómala do cordão umbilical e pela partilha muitas vezes desigual da placenta, fatores responsáveis pela síndrome de transfusão feto-fetal (STFF), restrição de crescimento intra-uterino (RCIU) e crescimento fetal discordante (CFD), com potenciais consequências nefastas para ambos os fetos. 4,[11][12][13]16,17 Os objetivos deste trabalho foram: caracterizar a população de gémeos fruto de gravidez bifetal nascidos num hospital nível três e avaliar o impacto da corionicidade na morbimortalidade perinatal.…”

Section: Introductionunclassified

Impacto da Corionicidade nas Complicações Perinatais da Gestação Gemelar

et al. 2017

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The incidence of multiple gestations is increasing worldwide and many studies have shown higher perinatal morbidity and mortality rates in monochorionic twins compared to dichorionic. The aim of this study was to assess the twin population born at a tertiary center and to evaluate the impact of chorionicity on perinatal outcomes of twin pregnancies. Material and Methods:Retrospective study of all twins born in a tertiary center from January 2004 to December 2013. Results: In this period, 1051 twins were born, related to 540 gestations (26.7% monochorionic; 73.3% dichorionic). There was no statistical significant difference between the groups concerning obstetric complications. The monochorionic group had a higher incidence of intrauterine growth restriction (20.5 vs 11.3%, p < 0.001), lower mean maternal age (29.9 vs 31.9 years, p < 0.001), lower mean gestational age (33.4 vs 34.3 weeks, p < 0.05) and lower mean birth weight (1943 vs 2147 g, p < 0.001). Monochorionic twins had a higher incidence of hyaline membrane disease (7 vs 4%, p < 0.05), sepsis (10.3 vs 5.8%, p < 0.05) and anemia (9.5 vs 5.4%, p < 0.05). There were no statistical significant differences concerning necrotizing enterocolitis, intraperiventricular hemorrhage or retinopathy of prematurity. Perinatal mortality was higher in the monochorionic group (5.2 vs 2.9%, p < 0.05). Discussion: Monochorionic twins represent considerable challenges to both obstetricians and neonatologists and should be monitored and delivered at tertiary centers. Conclusion: Currently gemelarity has a major impact on total births. It would be interesting to develop protocols to standardize clinical approach to twins.

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Twin chorionicity and the risk of adverse perinatal outcome

Abstract: The incidence of neonatal complications was higher in MC twins born of pregnancies complicated by TTS or sIUGR. Although the incidence of sIUGR was similar in MC and DC pregnancies, there was a trend towards worse outcomes in MC pregnancies affected by sIUGR.

Cited by 185 publications

References 23 publications

Stillbirth Rates and Risk Factors for Stillbirths among Zygotic Twins in Japan, 1995-2008

Stillbirth Rates and Risk Factors for Stillbirths among Zygotic Twins in Japan, 1995-2008

Placenta Share Discordance and Umbilical Artery Doppler Change After Antenatal Betamethasone Administration in Monochorionic Twins With Selective Intrauterine Growth Restriction: Is There a Link?

Impacto da Corionicidade nas Complicações Perinatais da Gestação Gemelar

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