General Obstetrics and Gynecology: Obstetrics
Persistance of adverse obstetric and neonatal outcomes in monochorionic twins after exclusion of disorders unique to monochorionic placentation

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Objective

This study was undertaken to assess obstetric and neonatal outcomes in dichorionic twins and monochorionic-diamniotic twins after exclusion of twin-to-twin transfusion syndrome and twin reversed arterial perfusion sequence.

Study design

Data from a tertiary center were collected in twin gestations between 1994 and 2002. Chorionicity was defined by standard echographic criteria and placental examination at delivery. Neonatal outcomes were compared between monochorionic and dichorionic gestations.

Results

This study included 503 women: 378 (75%) dichorionic and 125 (25%) monochorionic twin gestations. Monochorionic twin gestations had a higher risk of preterm deliveries between 30 and 34 weeks' gestation than pregnancies with dichorionic twins (P < .01). Monochorionic twins had a higher number of birth weight less than 10th percentile (P < .001) discordancy 25% or greater (P < .02), admission to neonatal intensive care unit (P < .03), and intraventricular hemorrhage grade 3 and 4 (P < .007) than dichorionic twins even after adjusting for gestational age.

Conclusion

Monochorionic diamniotic twins have a higher risk of perinatal complications than dichorionic twin gestations, even after exclusion of disorders unique to monochorionic placentation.

Section snippets

Material and methods

Data were prospectively collected in all twins monitored at our tertiary care center between April 1994 and January 2002. This database review was approved by our ethics board committee. Twin pregnancies complicated by TTTS, chromosomal and structural anomalies, monoamniotic twins, and intrauterine fetal death of 1 co-twin were not included in the analysis as well as any transfer to our center that occurred after 21 week's gestation. The diagnosis of TTTS was made according to Quintero's

Results

During the study period, 781 twin pregnancies were delivered at our center. Of these, 278 cases were excluded from the study because of the diagnosis of TTTS (n = 77), intrauterine fetal death of 1 or both fetuses (n = 31), chromosomal or structural anomalies (n = 20), monoamniotic twins (n = 21), or for transfer to our center after 21 weeks' gestation (n = 106). Twenty-three twin pairs were lost to follow-up. The study included 503 sets of twins with 378 dichorionic (DC) and 125 monochorionic

Comment

Our study examined a cohort of twin pregnancies followed at a single tertiary care center with a consistent method of managing twins and providing appropriate neonatal support. We compare the perinatal outcome in DC and MC twins after exclusion of conditions unique to MC twins such as TTTS and TRAP sequence. These peculiar complications of MC twin gestation play an important role in terms of morbidity and mortality in twins. We observed a higher risk of perinatal morbidity in MC diamniotic

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