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Lee DR, Lee S, Lee SJ. The effect of a vanishing twin on first- and second-trimester maternal serum markers and ultrasound screening for aneuploidy. Obstet Gynecol Sci 2023; 66:477-483. [PMID: 37532226 PMCID: PMC10663394 DOI: 10.5468/ogs.22270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 05/24/2023] [Accepted: 07/06/2023] [Indexed: 08/04/2023] Open
Abstract
A vanishing twin (VT) is the early demise of a twin fetus. It is estimated to occur in 20-30% of pregnancies associated with assisted reproductive technology. VT becomes increasingly prominent when assisted fertilization is used, because one or more embryos are transferred to the uterus. Maternal serum screening tests during pregnancy can screen for trisomy chromosomes 21, 18, and 13 and are divided into first- and second-trimester tests. In singleton pregnancies, the first trimester screening test is performed at 11-13 weeks and 6 days of gestation. It consists of two serum markers, pregnancy-associated plasma protein A and β-human chorionic gonadotropin (β-hCG), and measures nuchal translucency thickness. The second-trimester screening test was performed at 15-20 weeks and 6 days of gestation. It consists of four serum markers: alpha-fetoprotein, β-hCG, unconjugated estriol, and inhibin A. More effective screening for trisomy 21 in singleton pregnancies is achieved by analyzing cell-free DNA in the maternal blood. A VT includes a demise of the fetus. Although it affects maternal serum markers, it has not been corrected. Five studies examined the effect of VT on maternal serum markers, but the results were controversial. This study aimed to review the patterns of changes in maternal serum markers in VTs, interpret prenatal tests for pregnant women with VTs in clinical practice, and consider what information should be provided.
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Affiliation(s)
- Da Rae Lee
- Department of Obstetrics and Gynecology, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon,
Korea
| | - SeungMi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul,
Korea
| | - Se Jin Lee
- Department of Obstetrics and Gynecology, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon,
Korea
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2
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Lee SJ, Han YJ, Kim M, Shim JY, Lee MY, Oh SY, Lee J, Kim SH, Cha DH, Cho GJ, Kwon HS, Kim BJ, Park MH, Cho HY, Ko HS, Bae JH, Park CW, Park JS, Jun JK, Oh S, Lee DR, Ryu HM, Lee SM. The Effect of Vanishing Twin on First- and Second-Trimester Maternal Serum Markers and Nuchal Translucency: A Multicenter Prospective Cohort Study. J Korean Med Sci 2023; 38:e300. [PMID: 37750371 PMCID: PMC10519777 DOI: 10.3346/jkms.2023.38.e300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 05/30/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the effect of vanishing twin (VT) on maternal serum marker concentrations and nuchal translucency (NT). METHODS This is a secondary analysis of a multicenter prospective cohort study in 12 institutions. Serum concentrations of pregnancy-associated plasma protein-A in the first trimester and alpha-fetoprotein (AFP), total human chorionic gonadotrophin, unconjugated estriol, and inhibin A in the second trimester were measured, and NT was measured between 10 and 14 weeks of gestation. RESULTS Among 6,793 pregnant women, 5,381 women were measured for serum markers in the first or second trimester, including 65 cases in the VT group and 5,316 cases in the normal singleton group. The cases in the VT group had a higher median multiple of the median value of AFP and inhibin A than the normal singleton group. The values of other serum markers and NT were not different between the two groups. After the permutation test with adjustment, AFP and inhibin A remained significant differences. The frequency of abnormally increased AFP was also higher in the VT group than in the normal singleton group. CONCLUSION VT can be considered as an adjustment factor for risk assessment in the second-trimester serum screening test.
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Affiliation(s)
- Se Jin Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - You Jung Han
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Minhyoung Kim
- Department of Obstetrics and Gynecology, MizMedi Hospital, Seoul, Korea
| | - Jae-Yoon Shim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Mi-Young Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Soo-Young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - JoonHo Lee
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Soo Hyun Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Dong Hyun Cha
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Han-Sung Kwon
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Korea
| | - Byoung Jae Kim
- Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Mi Hye Park
- Department of Obstetrics and Gynecology, Ewha Womans University, Seoul, Korea
| | - Hee Young Cho
- Department of Obstetrics and Gynecology, Bundang CHA Hospital, CHA University School of Medicine, Seongnam, Korea
| | - Hyun Sun Ko
- Department of Obstetrics and Gynecology, Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ji Hye Bae
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Chan-Wook Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Joong Shin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Sohee Oh
- Medical Research Collaborating Center, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Da Rae Lee
- Department of Obstetrics and Gynecology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Hyun Mee Ryu
- Department of Obstetrics and Gynecology, Bundang CHA Hospital, CHA University School of Medicine, Seongnam, Korea.
| | - Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
- Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, Korea.
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3
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Wang Y, Qiu X, Chen S, Pan D, Hua R, Li S, Chen Y, Pan N, Cai X, Li J, Zhao X, Wang J, Jing R, Xiang G, Zhang Z, Huang HF, Xu C, Zhang J. Noninvasive Evaluation of Fetal Zygosity in Twin Pregnancies Involving a Binary Analysis of Single-Nucleotide Polymorphisms. J Mol Diagn 2023; 25:682-691. [PMID: 37599029 DOI: 10.1016/j.jmoldx.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 05/03/2023] [Accepted: 06/01/2023] [Indexed: 08/22/2023] Open
Abstract
Twin pregnancy constitutes significant risks for maternal and fetal health, which is usually detected by ultrasound examination at early gestation. However, the imaging-based approach may not accurately identify all twins confounded by practical or clinical variables. The analysis of fetal cell-free DNA in noninvasive prenatal screening assays can completement the ultrasound method for twin detection, which differentiates fraternal or identical twins based on their distinct genotypes. Here, a new noninvasive prenatal screening employing high-coverage next-generation sequencing for targeted nucleotide polymorphisms was developed for detection of zygosity and determination of fetal fraction in twin pregnancies. This method utilizes a binary analysis of both the number and allelic fraction of fetus-specific single-nucleotide polymorphisms to infer the zygosity. In 323 samples collected from 215 singleton, 90 dizygotic, and 18 monozygotic twin pregnancies, all 90 dizygotic twins were correctly detected, with a 100% sensitivity and a 100% specificity. In addition, this method can detect complex pregnancies, such as egg donors, contamination, and twins with complete hydatidiform mole. The fetus-specific fetal fraction change was monitored in nine dizygotic twin pregnancies, which demonstrated highly variable dynamics of fetal cell-free DNA turnover up to 7 weeks after twin reduction. Overall, this study provides a new noninvasive prenatal screening strategy for the accurate identification of twin zygosity and quantification of fetal fraction, which has important clinical implications for the management of twin pregnancies.
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Affiliation(s)
- Yanlin Wang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.
| | - Xiang Qiu
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
| | - Songchang Chen
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
| | - Dong Pan
- Beijing BioBiggen Technology Co., Ltd., Beijing, China
| | - Renyi Hua
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shuyuan Li
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Yiyao Chen
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Nina Pan
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoqiang Cai
- Beijing BioBiggen Technology Co., Ltd., Beijing, China
| | - Jianli Li
- Beijing BioBiggen Technology Co., Ltd., Beijing, China
| | - Xin Zhao
- Beijing BioBiggen Technology Co., Ltd., Beijing, China
| | - Jing Wang
- Beijing BioBiggen Technology Co., Ltd., Beijing, China
| | - Ruilin Jing
- Beijing BioBiggen Technology Co., Ltd., Beijing, China
| | - Guangxin Xiang
- Beijing BioBiggen Technology Co., Ltd., Beijing, China; School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Zhiwei Zhang
- Beijing BioBiggen Technology Co., Ltd., Beijing, China
| | - He-Feng Huang
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
| | - Chenming Xu
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
| | - Jinglan Zhang
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China; Beijing BioBiggen Technology Co., Ltd., Beijing, China.
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4
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Zou Y, Cui L, Xue M, Yan J, Huang M, Gao M, Gao X, Gao Y, Chen ZJ. Applications of noninvasive prenatal testing in vanishing twin syndrome pregnancies after treatment of assisted reproductive technology in a single center. Prenat Diagn 2020; 41:226-233. [PMID: 33009680 DOI: 10.1002/pd.5836] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/04/2020] [Accepted: 09/27/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The objective of the study is to assess the clinical application of noninvasive prenatal testing (NIPT) for VTS pregnancies after the treatment of assisted reproductive technology (ART). METHOD This was a retrospective study on VTS pregnancies through ART treatment. Participants underwent NIPT at 11 to 13 weeks gestation by sequencing. Resampling was recommended for both positive and testing failure cases. For NIPT positive results, participants were advised to have invasive testing. Clinical outcomes were obtained by telephone interview. RESULTS In total of 579 cases, testing failure rates after first sampling and resampling were 7.6% and 1.4%, respectively. Twelve positive results were reported by NIPT. But only one true positive was confirmed, giving a PPV of 8%. A total of 576 cases completed the follow-up (including 533 NIPT negative, 12 positive, and 31 testing failure) and three cases lost follow-up. Among the 536 cases with NIPT negative results, 504 (94.0%) resulted in live-birth and 29 (5.4%) resulted in miscarriage or stillbirths. No false-negative result was reported. CONCLUSION NIPT has the potential to be used in prenatal screening for VTS pregnancies. For the pregnant women who obtained positive and testing failure results, resampling after 15 weeks of gestation is recommended.
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Affiliation(s)
- Yang Zou
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China.,Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Linlin Cui
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China.,Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Mengyang Xue
- Department of Emergency and Chest Pain Center, Qilu Hospital, Shandong University, Jinan, China
| | - Junhao Yan
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China.,Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Miao Huang
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China.,Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Ming Gao
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China.,Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Xuan Gao
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China.,Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Yuan Gao
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China.,Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China.,Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China.,Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China.,Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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5
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Li YX, Sun TZ, Lv MQ, Zhou L, Ge P, Li HN, Zhou DX. Is vanishing twin syndrome associated with adverse obstetric outcomes of ART singletons? A systematic review and meta-analysis. J Assist Reprod Genet 2020; 37:2783-2796. [PMID: 32840763 DOI: 10.1007/s10815-020-01928-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/17/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The objective of our meta-analysis was to estimate the effect of VTS on obstetric outcomes of ART singletons. METHODS PubMed, Embase, MEDLINE, and ClinicalTrials.gov were searched up to January 2019 to find studies reporting the obstetric outcomes of ART singletons with VTS. Dichotomous data were expressed as odds ratios (OR) with 95% confidence intervals (CI). Continuous data were expressed as weighted mean difference (WMD) with 95% CI. RESULTS A total of 17 observational studies encompassing more than 60,000 ART singletons were included in this meta-analysis. The impact of VTS on singletons was highly dependent on the definition of VTS, precisely, the vanishing timing and intrauterine growth stage. When VTS happened at or before 14 weeks, regardless of intrauterine growth stage, there were no differences in terms of gestational age (GA) [WMD = - 0.08, 95% CI = - 0.27, 0.10], preterm birth (< 37 weeks) (PTB) [OR = 1.23, 95% CI = 0.89, 1.70], and low birth weight (< 2.5 kg) (LBW) [OR = 1.56, 95% CI = 1.00, 2.43] in original singletons versus singleton with VTS. On the contrary, VTS occurred after 14 weeks was associated with significantly shorter GW and lower BW, as well as higher risks of PTB and LBW. When the sac reduced in VTS was an empty gestational sac, there would be no differences in GW, PTB, and LBW between singletons versus singletons with VTS, whereas the loss of a fetus with cardiac-activity was associated with adverse obstetric outcomes. CONCLUSIONS This meta-analysis suggests whether or not VTS is harmful to obstetric outcomes is highly dependent on the vanishing timing and intrauterine growth stage.
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Affiliation(s)
- Yi-Xin Li
- Department of Pathology, Medical School, Xi'an Jiaotong University, Xi'an, 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, 710061, China
- Institute of Genetics and Developmental Biology, Xi'an, 710061, China
| | - Tian-Ze Sun
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, 710061, China
- Institute of Genetics and Developmental Biology, Xi'an, 710061, China
- Department of Human Anatomy and Histology and Embryology, Medical School, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Mo-Qi Lv
- Department of Pathology, Medical School, Xi'an Jiaotong University, Xi'an, 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, 710061, China
- Institute of Genetics and Developmental Biology, Xi'an, 710061, China
| | - Liang Zhou
- Reproductive Medicine Center, North-West Maternal and Child Hospital, Xi'an, 710003, China
| | - Pan Ge
- Department of Pathology, Medical School, Xi'an Jiaotong University, Xi'an, 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, 710061, China
- Institute of Genetics and Developmental Biology, Xi'an, 710061, China
| | - Hao-Nan Li
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, 710061, China
- Institute of Genetics and Developmental Biology, Xi'an, 710061, China
- Department of Pathogenic Biology and Immunology, Medical School, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Dang-Xia Zhou
- Department of Pathology, Medical School, Xi'an Jiaotong University, Xi'an, 710061, China.
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, 710061, China.
- Institute of Genetics and Developmental Biology, Xi'an, 710061, China.
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Chaveeva P, Wright A, Syngelaki A, Konstantinidou L, Wright D, Nicolaides KH. First-trimester screening for trisomies in pregnancies with vanishing twin. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:326-331. [PMID: 31710734 DOI: 10.1002/uog.21922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/29/2019] [Accepted: 10/31/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To examine multiples of the median (MoM) values of serum free beta-human chorionic gonadotropin (β-hCG) and pregnancy-associated plasma protein-A (PAPP-A) in a large series of pregnancies with a vanishing twin, determine the association of these values with the interval between embryonic death and blood sampling, and develop a model that would allow incorporation of these metabolites in first-trimester combined screening for trisomy. METHODS This was a retrospective study comparing maternal serum free β-hCG and PAPP-A levels at 11-13 weeks' gestation in 528 dichorionic pregnancies with a vanishing twin, including 194 (36.7%) with an empty gestational sac and 334 (63.3%) with a dead embryo, with those in 5280 normal singleton pregnancies matched for method of conception and date of examination. In vanishing-twin pregnancies with a dead embryo, marker levels were examined in relation to the estimated time between embryonic death and maternal blood sampling. RESULTS First, in pregnancies with a vanishing twin, median free β-hCG MoM was not significantly different from that in normal singleton pregnancies (1.000; 95% CI, 0.985-1.016 vs 0.995; 95% CI, 0.948-1.044; P = 0.849). Second, PAPP-A MoM was higher in vanishing-twin pregnancies than in normal singleton pregnancies (1.000; 95% CI, 0.985-1.015), both in the group with an empty gestational sac (1.165; 95% CI, 1.080-1.256; P = 0.0001) and in that with a dead embryo (1.175; 95% CI, 1.105-1.249; P < 0.0001). Third, in vanishing-twin pregnancies with a dead embryo, PAPP-A MoM was related inversely to the interval between estimated gestational age at embryonic demise and blood sampling (P < 0.0001). Fourth, in first-trimester screening for trisomy 21 in singleton pregnancies, the estimated detection rate, at a 5% false-positive rate, was 82% in screening by a combination of maternal age and fetal nuchal translucency thickness, and this increased to 86% with the addition of serum free β-hCG and to 91% with the addition of serum PAPP-A. Fifth, similar performance of screening can be achieved in pregnancies with a vanishing twin, provided the appropriate adjustments are made to the level of PAPP-A for the interval between estimated gestational age at embryonic demise and blood sampling. CONCLUSIONS First-trimester screening for trisomy in pregnancies with a vanishing twin should rely on a combination of maternal age, fetal nuchal translucency thickness and serum free β-hCG, as in singleton pregnancy, without the use of serum PAPP-A. Alternatively, PAPP-A can be included but only after appropriate adjustment for the interval between estimated gestational age at fetal demise and blood sampling. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- P Chaveeva
- Fetal Medicine Unit, Shterev Hospital, Sofia, Bulgaria
| | - A Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - A Syngelaki
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | | | - D Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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7
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Townsend R, Khalil A. Ultrasound surveillance in twin pregnancy: An update for practitioners. ULTRASOUND (LEEDS, ENGLAND) 2018; 26:193-205. [PMID: 30479634 PMCID: PMC6243450 DOI: 10.1177/1742271x18794013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 06/28/2018] [Indexed: 01/31/2023]
Abstract
Ultrasound has revolutionised the management of multiple pregnancies and their complications. Increasing frequency of twin pregnancies mandates familiarity of all clinicians with the relevant pathologies and evidence-based surveillance and management protocols for their care. In this review, we summarise the latest evidence relating to ultrasound surveillance of twin pregnancies including first trimester assessment and screening, growth surveillance and the detection and management of the complications of monochorionic pregnancies including twin-to-twin-transfusion syndrome, selective fetal growth restriction, twin reversed arterial perfusion sequence and conjoined twinning.
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Affiliation(s)
- R Townsend
- Fetal Medicine Unit, St. George's University of London, London, UK
| | - A Khalil
- Fetal Medicine Unit, St. George's University of London, London, UK
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8
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Shavit T, Oron G, Weon-Young S, Holzer H, Tulandi T. Vitrified-warmed single-embryo transfers may be associated with increased maternal complications compared with fresh single-embryo transfers. Reprod Biomed Online 2017; 35:94-102. [PMID: 28427857 DOI: 10.1016/j.rbmo.2017.03.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 03/15/2017] [Accepted: 03/21/2017] [Indexed: 12/22/2022]
Abstract
Cryopreservation of embryos allows single-embryo transfer and storage of supernumerary embryos, maximizing cumulative pregnancy rates. The purpose of this retrospective cohort study was to compare pregnancy outcome in singletons born after fresh or vitrified-warmed single blastocyst transfer (SBT). Singleton live births resulting from SBT of fresh or vitrified-warmed embryos were compared. Primary outcomes were perinatal outcomes including small for gestational age (SGA), low birthweight, preterm deliveries (PTD), large for gestational age (LGA) and congenital malformations. Maternal complications included pre-eclampsia, placenta previa, placental abruption, gestational diabetes mellitus (GDM) and chorioamnionitis. Adjustment for confounding factors was performed. Of 1886 fresh SBTs and 1200 vitrified-warmed SBTs during the study period, vitrified-warmed SBTs compared with fresh SBTs resulted in significantly lower clinical pregnancy rate (P < 0.0001). Live birth and miscarriage rates calculated only for pregnancy with known outcome revealed lower live birth rates and higher miscarriage rates for the vitrified-warmed group. Perinatal complications were calculated for clinical pregnancies with known outcomes (12.9% catchment failure was excluded from analysis). The vitrified-warmed group showed a trend toward higher rates of pre-eclampsia, GDM, Caesarean delivery and LGA neonates. Rates of PTD and SGA were comparable. In conclusion, vitrified-warmed SBT might be associated with increased feto-maternal complications.
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Affiliation(s)
- Tal Shavit
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Galia Oron
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Son Weon-Young
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Hananel Holzer
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Togas Tulandi
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
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Analysis of pregnancy outcomes for survivors of the vanishing twin syndrome after in vitro fertilization and embryo transfer. Eur J Obstet Gynecol Reprod Biol 2016; 203:35-9. [DOI: 10.1016/j.ejogrb.2016.04.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 03/05/2016] [Accepted: 04/05/2016] [Indexed: 11/23/2022]
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10
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Huang T, Boucher K, Aul R, Rashid S, Meschino WS. First and second trimester maternal serum markers in pregnancies with a vanishing twin. Prenat Diagn 2014; 35:90-6. [DOI: 10.1002/pd.4492] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/25/2014] [Accepted: 09/01/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Tianhua Huang
- Genetics Program; North York General Hospital; Toronto Ontario Canada
| | - Karen Boucher
- Genetics Program; North York General Hospital; Toronto Ontario Canada
| | - Ritu Aul
- Genetics Program; North York General Hospital; Toronto Ontario Canada
- Department of Paediatrics; University of Toronto; Toronto Ontario Canada
| | - Shamim Rashid
- Genetics Program; North York General Hospital; Toronto Ontario Canada
| | - Wendy S. Meschino
- Genetics Program; North York General Hospital; Toronto Ontario Canada
- Department of Paediatrics; University of Toronto; Toronto Ontario Canada
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11
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Monni G, Iuculano A, Zoppi MA. Screening and Invasive Testing in Twins. J Clin Med 2014; 3:865-82. [PMID: 26237482 PMCID: PMC4449657 DOI: 10.3390/jcm3030865] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 06/26/2014] [Accepted: 06/27/2014] [Indexed: 11/16/2022] Open
Abstract
Prenatal screening and testing for trisomy 21 in twin pregnancies poses a number of challenges: the exact estimate of the a priori risk of trisomy 21, the choice of prenatal screening test and/or invasive techniques to employ for the diagnosis and the impact of the result on the options of treatment in case of discordant results within a twin pair or among multiples. These different aspects are discussed below while recognizing that many issues remain unresolved.
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Affiliation(s)
- Giovanni Monni
- Department of Obstetrics and Gynecology, Prenatal and Preimplantation Genetic Diagnosis, Fetal Therapy, Ospedale Microcitemico, via Jenner, 09121 Cagliari, Italy.
| | - Ambra Iuculano
- Department of Obstetrics and Gynecology, Prenatal and Preimplantation Genetic Diagnosis, Fetal Therapy, Ospedale Microcitemico, via Jenner, 09121 Cagliari, Italy.
| | - Maria Angelica Zoppi
- Department of Obstetrics and Gynecology, Prenatal and Preimplantation Genetic Diagnosis, Fetal Therapy, Ospedale Microcitemico, via Jenner, 09121 Cagliari, Italy.
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12
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Down syndrome screening in assisted conception twins: an iatrogenic medical challenge. Obstet Gynecol Surv 2014; 68:825-34. [PMID: 24193195 DOI: 10.1097/ogx.0000000000000001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to provide a critical analysis of the impact of assisted conception on prenatal screening for Down syndrome (DS) in twin pregnancies and the value of various screening modalities for early detection of anomalies. METHODS The literature was searched using PubMed and the Cochrane Library focusing on prenatal screening and antenatal care of assisted-conception twin pregnancies. RESULTS Serum screening alone is of limited value in detecting aneuploid twins, because the unaffected cotwin can "mask" the abnormal serum results of an affected one. In addition, this test can designate the pregnancy as at high risk but not identify the affected fetus. Nuchal translucency (NT) screening is the best available modality and a highly effective screening method for twin pregnancies. Among twins, NT alone has a 69% DS detection rate, first-trimester combined NT and serum biochemistry has a 72% DS detection rate, and an integrated screen will have an 80% DS detection rate at a 5% FPR. The data in the literature concerning the effect of assisted conception on maternal serum screening markers in twin pregnancies are scarce. CONCLUSIONS Down syndrome screening in assisted-conception twins presents clinical and technical challenges. Therefore, assisted-conception twins need close monitoring from conception to delivery, by a practitioner familiar with the available screening modalities and their relative accuracy.
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Giorgetti C, Vanden Meerschaut F, De Roo C, Saunier O, Quarello E, Hairion D, Penaranda G, Chabert-Orsini V, De Sutter P. Multivariate analysis identifies the estradiol level at ovulation triggering as an independent predictor of the first trimester pregnancy-associated plasma protein-A level in IVF/ICSI pregnancies. Hum Reprod 2013; 28:2636-42. [DOI: 10.1093/humrep/det295] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Brady PC, Correia KF, Missmer SA, Hornstein MD, Barton SE. Early beta-human chorionic gonadotropin trends in vanishing twin pregnancies. Fertil Steril 2013; 100:116-21. [DOI: 10.1016/j.fertnstert.2013.02.057] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 02/20/2013] [Accepted: 02/28/2013] [Indexed: 11/16/2022]
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15
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Abstract
Twin gestations face an increased risk of structural abnormalities compared with singleton gestations, as well as an increased risk of aneuploidy. Accordingly, there is a need for accurate prenatal diagnosis of fetal genetic disorders and structural anomalies in twin gestations. Given the increased risk of congenital anomalies, a detailed sonographic survey of fetal anatomy is recommended in the early second trimester of twin gestations. In addition, fetal echocardiography should be considered in monochorionic twin gestations and in dichorionic twin pregnancies conceived using assisted reproductive technologies given the increased risk of congenital heart disease in these populations. Although first- and second-trimester aneuploidy screening in twin gestations is available, screening is less accurate than in singleton gestations. Invasive prenatal diagnosis in twin pregnancies is associated with a risk of pregnancy loss that is higher than the baseline risk of loss among twin gestations. Precise procedure-related loss rates in twin gestations undergoing chorionic villus sampling or amniocentesis, however, remain unclear because of methodological differences between published studies investigating diagnostic procedures in twins.
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Affiliation(s)
- Joy Vink
- Division of Maternal Fetal Medicine, Department of OB/GYN, Columbia University Medical Center, New York, NY 10032, USA.
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16
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Gjerris AC, Tabor A, Loft A, Christiansen M, Pinborg A. First trimester prenatal screening among women pregnant after IVF/ICSI. Hum Reprod Update 2012; 18:350-9. [DOI: 10.1093/humupd/dms010] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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17
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Are first-trimester screening markers altered in assisted reproductive technologies pregnancies? Curr Opin Obstet Gynecol 2011; 23:183-9. [PMID: 21415744 DOI: 10.1097/gco.0b013e3283455972] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review the current literature on first-trimester screening with respect to specific issues for assisted reproductive technologies (ARTs) singleton and twin pregnancies. RECENT FINDINGS A number of different first-trimester sonographic and biochemical markers have been validated in first-trimester screening for trisomy 21. Among sonographic markers, measurement of fetal nuchal translucency is the most investigated and least affected screening method in ART pregnancies, achieving comparable results in singletons and twins compared with spontaneous conceptions. The small deviation of nuchal translucency thickness observed in ART singletons did not influence overall screening performance, including the number of false-positive results. First-trimester maternal serum free β-human chorionic gonadotropin and pregnancy-associated plasma protein-A levels are more obviously altered in assisted conceptions and carry the risk of higher false-positive rates if not adjusted accordingly. The reason behind the alterations is currently not quite explored, but might be attributed to infertility and a higher incidence of placental disorders rather than to the use of ART. In twin pregnancies, chorionicity is an important confounding variable with evident impact on nuchal translucency measurements and maternal biochemistry, but both issues have not been sufficiently investigated in ART twins so far. SUMMARY First-trimester measurement of fetal nuchal translucency in singleton and twin gestations is associated with similar screening results when compared with spontaneous conception. Adjustments for the mode of conception are required if maternal serum biochemistry is included in the screening algorithm. Further studies on assisted conception twins are essential to permit more conclusive results on this issue.
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18
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Sankaran S, Rozette C, Dean J, Kyle P, Spencer K. Screening in the presence of a vanished twin: Nuchal translucency or combined screening test? Prenat Diagn 2011; 31:600-1. [DOI: 10.1002/pd.2735] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 12/23/2010] [Accepted: 02/05/2011] [Indexed: 10/18/2022]
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19
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Benoist G, Chéret-Benoist A, Beucher G, Dreyfus M. [Bleeding in the first trimester of pregnancy: diagnostic approach and therapeutic management]. J Gynecol Obstet Hum Reprod 2010; 39:F33-F39. [PMID: 20362403 DOI: 10.1016/j.jgyn.2010.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 12/18/2009] [Indexed: 05/29/2023]
Affiliation(s)
- G Benoist
- hôpital Georges-Clemenceau, CHU de Caen, France.
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20
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Bender F, Hecken J, Reinsberg J, Berg C, van der Ven H, Gembruch U, Geipel A. Altered first-trimester screening markers after IVF/ICSI: no relationship with small-for-gestational-age and number of embryos transferred. Reprod Biomed Online 2010; 20:516-22. [DOI: 10.1016/j.rbmo.2009.12.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Revised: 07/22/2009] [Accepted: 12/02/2009] [Indexed: 11/26/2022]
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21
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Spencer K, Staboulidou I, Nicolaides KH. First trimester aneuploidy screening in the presence of a vanishing twin: implications for maternal serum markers. Prenat Diagn 2010; 30:235-40. [DOI: 10.1002/pd.2445] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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22
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Ranta JK, Raatikainen K, Romppanen J, Pulkki K, Heinonen S. Increased time-to-pregnancy and first trimester Down's syndrome screening. Hum Reprod 2009; 25:412-7. [DOI: 10.1093/humrep/dep417] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Alhamdan D, Bora S, Condous G. Diagnosing twins in early pregnancy. Best Pract Res Clin Obstet Gynaecol 2009; 23:453-61. [DOI: 10.1016/j.bpobgyn.2009.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Accepted: 02/25/2009] [Indexed: 10/20/2022]
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van Oppenraaij R, Jauniaux E, Christiansen O, Horcajadas J, Farquharson R, Exalto N. Predicting adverse obstetric outcome after early pregnancy events and complications: a review. Hum Reprod Update 2009; 15:409-21. [DOI: 10.1093/humupd/dmp009] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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