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Manno JM, Marzan MB, Rolnik DL, Potenza S, Pritchard N, Said JM, Palmer KR, Whitehead CL, Sheehan PM, Ford J, Mol BW, Walker SP, Hui L. Reduction in spontaneous and iatrogenic preterm births in twin pregnancies during COVID-19 lockdown in Melbourne, Australia: a multicenter cohort study. BMC Pregnancy Childbirth 2023; 23:846. [PMID: 38082241 PMCID: PMC10712149 DOI: 10.1186/s12884-023-06137-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Melbourne, Australia, recorded one of the longest and most stringent pandemic lockdowns in 2020, which was associated with an increase in preterm stillbirths among singleton pregnancies. Twin pregnancies may be particularly susceptible to the impacts of pandemic disruptions to maternity care due to their higher background risk of adverse perinatal outcomes. METHODS Multicenter retrospective cohort study of all twin pregnancies birthing in public maternity hospitals in Melbourne. Multivariable log-binomial regression models were used to compare perinatal outcomes between a pre-pandemic group to women in whom weeks 20+0 to 40+0 of gestation occurred entirely during one of two lockdown-exposure periods: exposure 1 from 22 March 2020 to 21 March 2021 and exposure 2 from 22 March 2021 to 27 March 2022. RESULTS Total preterm births < 37 weeks were significantly lower in exposure 1 compared with the pre-pandemic period (63.1% vs 68.3%; adjusted risk ratio 0.92 95% CI 0.87-0.98, p = 0.01). This was mainly driven by fewer spontaneous preterm births (18.9% vs 20.3%; adjusted risk ratio 0.95 95% CI 0.90-0.99, p = 0.04). There were also lower rates of preterm birth < 34 weeks (19.9% vs 23.0%, adjusted risk ratio 0.93 95% CI 0.89-0.98 p = 0.01) and total iatrogenic births for fetal compromise (13.4% vs 20.4%; adjusted risk ratio 0.94 95% CI 0.89-0.98, p = 0.01). There were fewer special care nursery admissions (38.5% vs 43.4%; adjusted risk ratio 0.91 95% CI 0.87-0.95, p < 0.001) but no significant changes in stillbirth (1.5% vs 1.6%; adjusted risk ratio 1.00 95% CI 0.99-1.01, p = 0.82). Compared with the pre-pandemic period, there were more preterm births < 28 weeks and neonatal intensive care unit admissions in exposure 2. CONCLUSIONS Melbourne's first lockdown-exposure period was associated with lower preterm births in twins without significant differences in adverse newborn outcomes. Our findings provide insights into the influences on preterm birth and the optimal timing of delivery for twins.
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Affiliation(s)
- Juliana M Manno
- Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | - Melvin B Marzan
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Mercy Health, Heidelberg, Australia
- Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville, Australia
| | - Daniel L Rolnik
- Department of Obstetrics and Gynaecology, Monash Health, Clayton, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Stephanie Potenza
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Mercy Health, Heidelberg, Australia
| | - Natasha Pritchard
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Mercy Health, Heidelberg, Australia
| | - Joanne M Said
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- Maternal-Fetal Medicine Department, Joan Kirner Women's and Children's Hospital, Western Health, St Albans, Australia
| | - Kirsten R Palmer
- Department of Obstetrics and Gynaecology, Monash Health, Clayton, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Clare L Whitehead
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Parkville, Australia
| | - Penelope M Sheehan
- Department of Obstetrics and Gynaecology, Monash Health, Clayton, Australia
- Department of Obstetrics and Gynaecology, Eastern Health, Box Hill, Australia
| | - Jolyon Ford
- Department of Obstetrics and Gynaecology, Peninsula Health, Frankston, Australia
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash Health, Clayton, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Susan P Walker
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Mercy Health, Heidelberg, Australia
| | - Lisa Hui
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Parkville, Australia.
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Mercy Health, Heidelberg, Australia.
- Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville, Australia.
- Department of Obstetrics and Gynaecology, The Northern Hospital, Northern Health, Epping, Australia.
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Cruz-Martínez R, Villalobos-Gómez R, Gil-Pugliese S, Gámez-Varela A, López-Briones H, Martínez-Rodríguez M, Barrios-Prieto E. Management of atypical cases of twin-to-twin transfusion syndrome. Best Pract Res Clin Obstet Gynaecol 2022; 84:155-165. [PMID: 35490103 DOI: 10.1016/j.bpobgyn.2022.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/13/2022] [Indexed: 11/02/2022]
Abstract
Up to 20% of monochorionic diamniotic twin pregnancies can be complicated with twin-to-twin transfusion syndrome (TTTS). This complication is diagnosed by ultrasound demonstrating amniotic fluid discordance between both amniotic sacs, with polyhydramnios in the recipient's sac and oligohydramnios in the donor's, secondary to an imbalance in blood volume exchange between twins. Ultrasound evaluation of the amniotic fluid volume, bladder filling, and assessment of fetal Doppler parameters provide the basis for classification of TTTS, allowing severity assessment. The Quintero's staging system provides a standardized prenatal estimate on the risk of intrauterine fetal demise of one or both twins and the need for fetoscopic laser coagulation of placental vascular anastomoses or delivery depending on the gestational age. However, a proportion of TTTS cases may present without a linear progressive deterioration and no ultrasound signs of preceding staging, in rare situations, they arise even without amniotic fluid discordance. Thus, these unusual clinical presentations of TTTS have long been grouped into the category of atypical TTTS. In this review, we show the clues for diagnosis and management of different atypical cases of TTTS highlighting their underlying mechanism to improve the clinical understanding of such atypical situations, avoid misdiagnosis of TTTS, and allow a timely referral to a fetoscopic center.
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Affiliation(s)
- Rogelio Cruz-Martínez
- Fetal Medicine and Surgery Center, Medicina Fetal México, Guadalajara, Jalisco, Mexico; Department of Maternal-Fetal Medicine, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Jalisco, Mexico; Fetal Medicine Center, Medicina Fetal México, Querétaro, Mexico.
| | - Rosa Villalobos-Gómez
- Fetal Medicine and Surgery Center, Medicina Fetal México, Guadalajara, Jalisco, Mexico; Department of Maternal-Fetal Medicine, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Jalisco, Mexico; Fetal Medicine Center, Medicina Fetal México, Querétaro, Mexico
| | | | - Alma Gámez-Varela
- Fetal Medicine and Surgery Center, Medicina Fetal México, Guadalajara, Jalisco, Mexico
| | | | - Miguel Martínez-Rodríguez
- Fetal Medicine and Surgery Center, Medicina Fetal México, Guadalajara, Jalisco, Mexico; Department of Maternal-Fetal Medicine, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Jalisco, Mexico
| | - Ernesto Barrios-Prieto
- Department of Maternal-Fetal Medicine, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Jalisco, Mexico
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