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D'antonio F, Prasad S, Masciullo L, Eltaweel N, Khalil A. Selective fetal growth restriction in dichorionic diamniotic twin pregnancy: systematic review and meta-analysis of pregnancy and perinatal outcomes. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:164-172. [PMID: 37519089 DOI: 10.1002/uog.26302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/27/2023] [Accepted: 06/05/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE Most of the published literature on selective fetal growth restriction (sFGR) has focused on monochorionic twin pregnancies. The aim of this systematic review was to report on the outcome of dichorionic diamniotic (DCDA) twin pregnancies complicated by sFGR. METHODS MEDLINE, EMBASE and The Cochrane Library databases were searched. The inclusion criteria were DCDA twin pregnancies complicated by sFGR. The outcomes explored were intrauterine death (IUD), neonatal death and perinatal death (PND), survival of at least one and both twins, preterm birth (PTB) (either spontaneous or iatrogenic) prior to 37, 34, 32 and 28 weeks' gestation, pre-eclampsia (PE) or gestational hypertension, neurological, respiratory and infectious morbidity, Apgar score < 7 at 5 min, necrotizing enterocolitis, retinopathy of prematurity and admission to the neonatal intensive care unit (NICU). A composite outcome of neonatal morbidity, defined as the occurrence of respiratory, neurological or infectious morbidity, was also evaluated. Random-effects meta-analysis was used to analyze the data, and results are reported as pooled proportion or odds ratio (OR) with 95% CI. RESULTS Thirteen studies reporting on 1339 pregnancies with sFGR and 6316 pregnancies without sFGR were included. IUD occurred in 2.6% (95% CI, 1.1-4.7%) of fetuses from DCDA pregnancies with sFGR and 0.6% (95% CI, 0.3-9.7%) of those from DCDA pregnancies without sFGR, while the respective values for PND were 5.2% (95% CI, 3.5-7.3%) and 1.7% (95% CI, 0.1-5.7%). Spontaneous or iatrogenic PTB before 37 weeks complicated 84.1% (95% CI, 55.6-99.2%) of pregnancies with sFGR and 69.1% (95% CI, 45.4-88.4%) of those without sFGR. The respective values for PTB before 34, 32 and 28 weeks were 18.4% (95% CI, 4.4-38.9%), 13.0% (95% CI, 9.5-17.1%) and 1.5% (95% CI, 0.6-2.3%) in pregnancies with sFGR and 10.2% (95% CI, 3.1-20.7%), 7.8% (95% CI, 6.8-9.0%) and 1.8% (95% CI, 1.3-2.4%) in those without sFGR. PE or gestational hypertension complicated 19.9% (95% CI, 12.4-28.6%) of pregnancies with sFGR and 12.8% (95% CI, 10.4-15.4%) of those without sFGR. Composite morbidity occurred in 28.2% (95% CI, 7.8-55.1%) of fetuses from pregnancies with sFGR and 13.9% (95% CI, 6.5-23.5%) of those from pregnancies without sFGR. When stratified according to the sFGR status within a twin pair, composite morbidity occurred in 39.0% (95% CI, 11.1-71.5%) of growth-restricted fetuses and 29.9% (95% CI, 3.5-65.0%) of appropriately grown fetuses (OR, 1.9 (95% CI, 1.7-3.1)), while the respective values for PND were 3.0% (95% CI, 1.8-4.5%) and 1.6% (95% CI, 0.9-2.6%) (OR, 2.1 (95% CI, 1.0-4.1)). On risk analysis, DCDA pregnancies complicated by sFGR had a significantly higher risk of IUD (OR, 5.2 (95% CI, 3.2-8.6)) and composite morbidity or admission to the NICU (OR, 3.2 (95% CI, 1.9-5.6)) compared to those without sFGR, while there was no difference in the risk of PTB before 34 weeks (P = 0.220) or PE/gestational hypertension (P = 0.210). CONCLUSIONS DCDA twin pregnancies complicated by sFGR are at high risk of perinatal morbidity and mortality. The findings of this systematic review are relevant for counseling and management of complicated DCDA twin pregnancies, in which twin-specific, rather than singleton, outcome data should be used. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- F D'antonio
- Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy
| | - S Prasad
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Twins Trust Centre for Research and Clinical Excellence, St George's University Hospital, St George's University of London, London, UK
| | - L Masciullo
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Twins Trust Centre for Research and Clinical Excellence, St George's University Hospital, St George's University of London, London, UK
| | - N Eltaweel
- Division of Biomedical Science, Warwick Medical School, University of Warwick, University Hospital of Coventry and Warwickshire, Coventry, UK
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Twins Trust Centre for Research and Clinical Excellence, St George's University Hospital, St George's University of London, London, UK
- Fetal Medicine Unit, Liverpool Women's Hospital, University of Liverpool, Liverpool, UK
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Perinatal Outcomes and Neurodevelopment 1 Year after Birth in Discordant Twins According to Chorionicity. Medicina (B Aires) 2023; 59:medicina59030493. [PMID: 36984492 PMCID: PMC10054047 DOI: 10.3390/medicina59030493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/19/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Background and Objectives: This study aimed to compare maternal complications, perinatal outcomes, and neurodevelopment 1 year after the birth between concordant and discordant twins in monochorionic and dichorionic twins. Materials and Methods: This retrospective study included twin pregnancies delivered between 24 + 1 and 38 + 2 weeks of gestation between January 2011 and September 2019. Chorionicity was confirmed by ultrasonography and was categorized into monochorionic and dichorionic. Each was then divided into two groups (concordant and discordant) according to birth weight discordancy. Maternal complications and neonatal outcomes, including neurodevelopmental delays, were compared between the two groups. Results: A total of 298 pairs of twin pregnancies were enrolled, of which 58 (19.26%) women were pregnant with monochorionic diamniotic twins and 240 (80.54%) with dichorionic diamniotic twins. In both monochorionic and dichorionic twins, the discordant twins had a greater incidence of emergency deliveries because of iatrogenic causes than the concordant twins. Among dichorionic twins, discordant twins had lower birth weight rates and higher hospitalization rates and morbidities than concordant twins. Among monochorionic twins, discordant twins had a lower birth weight and higher neonatal mortality than concordant twins. The neonatal size was not a predictor of neurodevelopment in this group. Based on the logistic regression analysis, male sex, respiratory distress syndrome, and bronchopulmonary dysplasia were risk factors for the neurodevelopmental delay; birth weight discordancy was significant only in dichorionic twins. Conclusions: Perinatal outcomes in discordant twins may be poor, and neurodevelopment 1 year after birth was worse in discordant twins than in concordant twins. Discordancy in twins can be a risk factor for neurodevelopmental delay.
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Anderson JN, Deter RL, Datoc IA, Mack L, Gandhi M, Lee W, Blumenfeld YJ. Second-trimester growth velocities in twin and singleton pregnancies. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:33-39. [PMID: 36273412 DOI: 10.1002/uog.26102] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/04/2022] [Accepted: 10/14/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Previous small studies used individualized growth assessment (IGA) to characterize prenatal growth velocities of singletons and twins. We aimed to compare second-trimester growth velocities of individual anatomical parameters between monochorionic diamniotic (MCDA) twins, dichorionic diamniotic (DCDA) twins and singleton fetuses in a larger study. METHODS This was a study of a novel cohort of 222 MCDA twins and previously published cohorts of 40 DCDA twins and 118 singletons with serial ultrasound data. Fetal biometric measurements of biparietal diameter, head circumference, abdominal circumference and femur diaphysis length from prenatal ultrasound examinations were used to calculate second-trimester growth velocities using direct calculation or linear regression analysis. Linear fit was assessed based on the coefficient of determination (R2 ). Mean growth velocities and variances were compared among the three groups. RESULTS The majority of cases underwent three second-trimester ultrasound examinations with fetal biometry available. All fetuses had linear growth, with R2 > 99% for all parameters. Only 1-2% of all MCDA and DCDA anatomical parameters had abnormal growth velocity scores outside the 95% reference range for singletons. There were no significant differences in mean growth velocity for any parameter between MCDA twins and singletons. Femur diaphysis length growth velocity was significantly lower in DCDA twins than in both MCDA twins and singletons. There were no other significant differences among the groups. CONCLUSIONS Expanding on prior work using IGA, we found that second-trimester growth velocity of the four major anatomical parameters overall was similar between twins and singletons and between MCDA and DCDA twins, supporting the use of singleton-derived growth standards for IGA in twins. Twin growth potential appears to be similar to that of singletons in the second trimester, suggesting that subsequent growth divergence may be due to third-trimester physiological or pathological changes in twin pregnancies. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- J N Anderson
- Stanford University School of Medicine, Department of Obstetrics and Gynecology, Stanford, CA, USA
| | - R L Deter
- Baylor College of Medicine/Texas Children's Pavilion for Women, Department of Obstetrics and Gynecology, Houston, TX, USA
| | - I A Datoc
- Stanford University School of Medicine, Department of Obstetrics and Gynecology, Stanford, CA, USA
| | - L Mack
- Baylor College of Medicine/Texas Children's Pavilion for Women, Department of Obstetrics and Gynecology, Houston, TX, USA
| | - M Gandhi
- Baylor College of Medicine/Texas Children's Pavilion for Women, Department of Obstetrics and Gynecology, Houston, TX, USA
| | - W Lee
- Baylor College of Medicine/Texas Children's Pavilion for Women, Department of Obstetrics and Gynecology, Houston, TX, USA
| | - Y J Blumenfeld
- Stanford University School of Medicine, Department of Obstetrics and Gynecology, Stanford, CA, USA
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Rahimi-Sharbaf F, Shirazi M, Golshahi F, Salari Z, Haghiri M, Ghaemi M, Feizmahdavi H. Comparison of Prenatal and Neonatal Outcomes of Selective Fetal Growth Restriction in Monochorionic Twin Pregnancies with or Without Twin-to-Twin Transfusion Syndrome After Radiofrequency Ablation. IRANIAN JOURNAL OF MEDICAL SCIENCES 2022; 47:433-439. [PMID: 36117585 PMCID: PMC9445864 DOI: 10.30476/ijms.2021.91097.2217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/30/2021] [Accepted: 08/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study aimed to investigate and compare the prenatal and neonatal outcomes of monochorionic twin pregnancies complicated with fetal growth restriction (sFGR) with or without twin-to-twin transfusion syndrome (TTTS) after cord occlusion by radiofrequency ablation (RFA). METHODS This prospective cross-sectional study was conducted in women with monochorionic twin pregnancies of 16 to 26 weeks of gestational age (GA) in an academic hospital from 2016 to 2020. Demographic and obstetrical characteristics such as cervical length, GA of RFA and delivery, amnioreduction, cesarean section (C/S) rate, and maximum vertical pocket as well as prenatal, neonatal, and maternal outcomes were evaluated and compared between groups using Statistical Package for the Social Sciences (SPSS). Mann-Whitney U test or independent t test was used for quantitative data and Chi square test was applied for comparing qualitative variables. The significance level of tests was 0.05. RESULTS Totally 213 (106 sFGR and 107 TTTS+sFGR) cases were enrolled. The mean of maternal age (P=0.787), body mass index (P=0.932), gestational age at RFA (P=0.265), as well as gestational age of delivery (P=0.482), and C/S rate (P=0.124) were not significant between the two groups, but a significant difference (P<0.001) in cervical length was observed between the two groups. No significant differences were found in newborn and fetal outcomes such as fetal demise (P=0.827), PPROM (P=0.233), abortion (P=0.088), and admission to intensive care unit (P=0.822) between the groups. CONCLUSION Although worse fetal and neonatal outcomes were expected in the TTTS+sFGR group after RFA, no significant difference was observed between groups.
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Affiliation(s)
- Fatemeh Rahimi-Sharbaf
- Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboobeh Shirazi
- Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran,
Maternal Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Golshahi
- Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran,
Maternal Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Salari
- Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansoureh Haghiri
- Department of Perinatology, Maternal, Fetal and Neonatal Research Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Marjan Ghaemi
- Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hanieh Feizmahdavi
- Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran,
Department of Obstetrics and Gynecology, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Rizzini N, Fratelli N, Negri B, Odicino FE, Sartori E, Risso FM, Prefumo F, Fichera A. Chorionicity, birth weight discordance and neonatal morbidity in uncomplicated twin pregnancies delivered from 36 weeks. Eur J Obstet Gynecol Reprod Biol 2022; 271:214-218. [PMID: 35228093 DOI: 10.1016/j.ejogrb.2022.02.021] [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: 09/21/2021] [Revised: 02/14/2022] [Accepted: 02/19/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the association between chorionicity, birth weight discordance and neonatal morbidity in uncomplicated twin pregnancies progressing to at least 36 weeks of gestation. STUDY DESIGN This was a retrospective single centre cohort study of all twin pregnancies referred to our twin clinic between 2011 and 2018. Outcome details were obtained from the computerized maternity and neonatal records. The primary outcome was incidence of composite neonatal morbidity according to chorionicity. We also determined the incidence of composite neonatal morbidity in pregnancies with birth weight discordance. Logistic regression was used to identify and adjust for potential confounders. RESULTS Three hundred and eighty-five twin pregnancies (286 dichorionic, 99 monochorionic) were included. Gestational age at birth was significantly lower in pregnancies complicated by neonatal morbidity (p = 0.013) compared with those which were not. On multivariable logistic regression analysis, gestational age at birth (p = 0.031) and birth weight discordance (p = 0.004), but not chorionicity (p = 0.626) were independently associated with neonatal morbidity. CONCLUSION(S) In uncomplicated twin pregnancies chorionicity is not associated with neonatal morbidity. Gestational age at birth is the major determinant of neonatal outcome while the clinical impact of weight discordance seems marginally significant.
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Affiliation(s)
- Nicoletta Rizzini
- Division of Obstetrics and Gynecology, ASST Spedali Civili, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Nicola Fratelli
- Division of Obstetrics and Gynecology, ASST Spedali Civili, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Beatrice Negri
- Division of Obstetrics and Gynecology, ASST Spedali Civili, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Franco E Odicino
- Division of Obstetrics and Gynecology, ASST Spedali Civili, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Enrico Sartori
- Division of Obstetrics and Gynecology, ASST Spedali Civili, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Francesco M Risso
- Neonatalogy and Neonatal Intensive Care Unit, ASST Spedali Civili, Brescia, Italy
| | - Federico Prefumo
- Division of Obstetrics and Gynecology, ASST Spedali Civili, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | - Anna Fichera
- Division of Obstetrics and Gynecology, ASST Spedali Civili, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Gremillet L, Netter A, Tosello B, D'Ercole C, Bretelle F, Chau C. Selective intrauterine growth restriction of monochorionic diamniotic twin pregnancies: What is the neonatal prognosis? J Gynecol Obstet Hum Reprod 2021; 51:102304. [PMID: 34974148 DOI: 10.1016/j.jogoh.2021.102304] [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: 07/29/2021] [Revised: 12/12/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study compares the neonatal morbidity and mortality of the smallest twins of monochorionic diamniotic (MCDA) pregnancies complicated with selective intrauterine growth restriction (sIUGR) with newborns from singleton pregnancies with intrauterine growth restriction (IUGR). METHODS We conducted a retrospective cohort study of patients managed at the prenatal diagnosis center in a single tertiary care hospital between 2012 and 2019. MCDA twin pregnancies complicated with sIUGR (sIUGR group) were compared with singleton pregnancies with IUGR (IUGR group). The primary outcome was the comparison in neonatal morbidity and mortality between the two groups. RESULTS The analysis included 251 patients: 67 in the sIUGR group and 184 in the IUGR group. The two groups were comparable in gestational age and birth weight (p > 0.05). Multivariate analysis controlling for factors that may influence neonatal status showed no significant difference between the two groups in any of the neonatal morbidity criteria or the composite morbidity-mortality endpoint (adjusted OR = 0.946 [95% CI = 0.317-2.827]; p = 0.921). CONCLUSION Despite supposedly different pathophysiological mechanisms, neonates from MCDA pregnancies complicated with sIUGR and those from singleton pregnancies with IUGR appear to have identical neonatal morbidity and mortality .
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Affiliation(s)
- Letizia Gremillet
- Department of Gynecology and Obstetrics, AP-HM, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Antoine Netter
- Department of Gynecology and Obstetrics, AP-HM, Assistance Publique-Hôpitaux de Marseille, Marseille, France; Aix Marseille Univ, Avignon University, CNRS, IRD, IMBE, Marseille, France.
| | - Barthélemy Tosello
- Department of Neonatal Medicine, North Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France; CNRS, EFS, ADES, Aix-Marseille Univ, Marseille, France
| | - Claude D'Ercole
- Department of Gynecology and Obstetrics, AP-HM, Assistance Publique-Hôpitaux de Marseille, Marseille, France; EA3279, CEReSS, Health Service Research and Quality of Life Center, Aix-Marseille University, 13284, Marseille, France
| | - Florence Bretelle
- Department of Gynecology and Obstetrics, AP-HM, Assistance Publique-Hôpitaux de Marseille, Marseille, France; Research Unit on Tropical and Emerging Infectious Diseases, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille, France
| | - Cécile Chau
- Department of Gynecology and Obstetrics, AP-HM, Assistance Publique-Hôpitaux de Marseille, Marseille, France
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Marleen S, Dias C, Nandasena R, MacGregor R, Allotey J, Aquilina J, Khalil A, Thangaratinam S. Association between chorionicity and preterm birth in twin pregnancies: a systematic review involving 29 864 twin pregnancies. BJOG 2020; 128:788-796. [PMID: 32888235 DOI: 10.1111/1471-0528.16479] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The perinatal mortality and morbidity among twins vary by chorionicity. Although it is considered that monochorionicity is associated with an increased risk of preterm birth in twin pregnancies, no systematic review exists evaluating this association. OBJECTIVES This systematic review was undertaken to assess the association between preterm birth and chorionicity in twin pregnancies. SEARCH STRATEGY We searched the electronic databases from January 1990 to July 2019 without language restrictions. SELECTION CRITERIA All studies on twin pregnancies where chorionicity and preterm birth were evaluated were included. DATA COLLECTION AND ANALYSIS Findings are reported as odds ratios with 95% confidence intervals. The estimates are pooled using random-effects meta-analysis. MAIN RESULTS From 13 156 citations, we included 39 studies (29 864 pregnancies). Monochorionicity was significantly associated with increased risk of preterm birth at ≤28, ≤32, ≤34 and <37 weeks in women asymptomatic and symptomatic for preterm labour (odds ratio [OR] 2.14, 95% CI 1.52-3.02, I2 = 46%, OR 1.55, 95% CI 1.27-1.89 I2 = 68%, OR 1.47, 95% CI 1.27-1.69, I2 = 60%, OR 1.66, 95% CI 1.43-1.93, I2 = 65%, respectively). Among those asymptomatic for preterm labour, significantly increased odds of preterm birth were seen for monochorionicity at gestations ≤34 weeks (OR 1.85, 95% CI 1.42-2.40, I2 = 25%) and <37 weeks (OR 1.75, 95% CI 1.22-2.53, I2 = 61%). Sensitivity analysis showed significantly increased odds of spontaneous preterm birth at ≤34 and <37 weeks for monochorionicity (OR 1.25, 95% CI 1.01-1.55, I2 = 0% and OR 1.41, 95% CI 1.13-1.78, I2 = 0%). CONCLUSIONS Monochorionicity is significantly associated with preterm birth at all gestations. TWEETABLE ABSTRACT In twin pregnancies, monochorionicity is associated with an increased risk of preterm birth at all gestations.
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Affiliation(s)
- S Marleen
- Barts Research Centre for Women's Health (BARC), Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Sri Jayewardenepura Postgraduate Teaching Hospital, Nugegoda, Sri Lanka
| | - C Dias
- Sri Jayewardenepura Postgraduate Teaching Hospital, Nugegoda, Sri Lanka
| | - R Nandasena
- Sri Jayewardenepura Postgraduate Teaching Hospital, Nugegoda, Sri Lanka
| | - R MacGregor
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | - J Allotey
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - J Aquilina
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | - A Khalil
- St George's University Hospitals NHS Foundation Trust, London, UK.,Molecular and Clinical Sciences Research Institute, St George's Medical School, University of London, London, UK
| | - S Thangaratinam
- World Health Organization (WHO) Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
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Antonakopoulos N, Pateisky P, Liu B, Kalafat E, Thilaganathan B, Khalil A. Selective Fetal Growth Restriction in Dichorionic Twin Pregnancies: Diagnosis, Natural History, and Perinatal Outcome. J Clin Med 2020; 9:E1404. [PMID: 32397539 PMCID: PMC7290824 DOI: 10.3390/jcm9051404] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/22/2020] [Accepted: 04/28/2020] [Indexed: 12/22/2022] Open
Abstract
This study aims to evaluate the natural history, disease progression, and outcomes in dichorionic twins with selective fetal growth restriction (sFGR) according to different diagnostic criteria and time of onset. Dichorionic twins seen from the first trimester were included. sFGR was classified according to the Delphi consensus, and was compared to the outcomes of those classified by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) diagnostic criteria. Early sFGR occurred before 32-weeks, and late sFGR after 32-weeks. Disease progression, neonatal outcomes such as gestation at delivery, birthweight, neonatal unit (NNU) admission, and morbidities were compared. One-hundred twenty-three of 1053 dichorionic twins had sFGR, where 8.4% were classified as early sFGR, and 3.3% were late sFGR. Disease progression was seen in 36%, with a longer progression time (5 vs. 1 week) and higher progression rate (40% vs. 26%) in early sFGR. Perinatal death was significantly higher in the sFGR than the non-sFGR group (24 vs. 16 per 1000 births, p = 0.018), and those with early sFGR had more NNU admissions than late sFGR (p = 0.005). The ISUOG diagnostic criteria yielded a higher number of sFGR than the Delphi criteria, but similar outcomes. sFGR have worse perinatal outcomes, with early onset being more prevalent. Use of the Delphi diagnostic criteria can reduce over-diagnosis of sFGR and avoid unnecessary intervention.
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Affiliation(s)
- Nikolaos Antonakopoulos
- Fetal Medicine Unit, St George’s University Hospitals, Blackshaw Road, London SW17 0QT, UK; (N.A.); (P.P.); (B.L.); (B.T.)
- 3rd Department of Obstetrics Gynaecology and Feto-Maternal Medicine, University of Athens Medical School, Attikon Hospital & Gynecology Obstetrics and Perinatal Medicine Unit, Evgenideio Hospital, 11528 Athens, Greece
| | - Petra Pateisky
- Fetal Medicine Unit, St George’s University Hospitals, Blackshaw Road, London SW17 0QT, UK; (N.A.); (P.P.); (B.L.); (B.T.)
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynaecology, Medical University of Vienna, 1090 Vienna, Austria
| | - Becky Liu
- Fetal Medicine Unit, St George’s University Hospitals, Blackshaw Road, London SW17 0QT, UK; (N.A.); (P.P.); (B.L.); (B.T.)
| | - Erkan Kalafat
- Department of Statistics, Faculty of Arts and Sciences, Middle East Technical University, Ankara 06800, Turkey;
| | - Baskaran Thilaganathan
- Fetal Medicine Unit, St George’s University Hospitals, Blackshaw Road, London SW17 0QT, UK; (N.A.); (P.P.); (B.L.); (B.T.)
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Asma Khalil
- Fetal Medicine Unit, St George’s University Hospitals, Blackshaw Road, London SW17 0QT, UK; (N.A.); (P.P.); (B.L.); (B.T.)
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, Cranmer Terrace, London SW17 0RE, UK
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Tosello B, Garbi A, Blanc J, Lorthe E, Foix-L'Hélias L, D'Ercole C, Winer N, Subtil D, Goffinet F, Kayem G, Resseguier N, Gire C. The impact of chorionicity on pregnancy outcome and neurodevelopment at 2 years old among twins born preterm: the EPIPAGE-2 cohort study. BJOG 2020; 128:281-291. [PMID: 32048439 DOI: 10.1111/1471-0528.16170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the short- and mid-term outcomes of preterm twins by chorionicity of pregnancy. DESIGN Prospective nationwide population-based EPIPAGE-2 cohort study. SETTING 546 maternity units in France, between March and December 2011. POPULATION A total of 1700 twin neonates born between 24 and 34 weeks of gestation. METHODS The association of chorionicity with outcomes was analysed using multivariate regression models. MAIN OUTCOME MEASURES First, survival at 2-year corrected age with or without neurosensory impairment, and second, perinatal, short-, and mid-term outcomes (survival at discharge, survival at discharge without severe morbidity) were described and compared by chorionicity. RESULTS In the EPIPAGE 2 cohort, 1700 preterm births were included (850 twin pregnancies). In all, 1220 (71.8%) were from dichorionic (DC) pregnancies and 480 from monochorionic (MC) pregnancies. MC pregnancies had three times more medical terminations than DC pregnancies (1.67 versus 0.51%, P < 0.001), whereas there were three times more stillbirths in MC than in DC pregnancies (10.09 versus 3.78%, P < 0.001). Both twins were alive at birth in 86.6% of DC pregnancies compared with 80.0% among MC pregnancies (P = 0.008). No significant difference according to chorionicity was found regarding neonatal deaths and morbidities. Likewise, for children born earlier than 32 weeks, the 2-year follow-up neurodevelopmental results were not significantly different between DC and MC twins. CONCLUSIONS This study confirms that MC pregnancies have a higher risk of adverse outcomes. However, the outcomes among preterm twins admitted to neonatal intensive care units are similar irrespective of chorionicity. TWEETABLE ABSTRACT Monochorionicity is associated with adverse perinatal outcomes, but outcomes for preterm twins are comparable irrespective of their chorionicity.
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Affiliation(s)
- B Tosello
- Department of Neonatology, North Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France.,CNRS, EFS, ADES, Aix-Marseille Univ, Marseille, France
| | - A Garbi
- Department of Neonatology, North Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - J Blanc
- Department of Obstetrics and Gynecology, Nord Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France.,EA 3279, CEReSS, Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - E Lorthe
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Research Center for Epidemiology and BioStatistics Sorbonne Paris Cité (CRESS), DHU Risks in pregnancy, Paris Descartes University, Paris, France.,EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal
| | - L Foix-L'Hélias
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Research Center for Epidemiology and BioStatistics Sorbonne Paris Cité (CRESS), DHU Risks in pregnancy, Paris Descartes University, Paris, France.,Department of Neonatology, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - C D'Ercole
- Department of Obstetrics and Gynecology, Nord Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - N Winer
- Unité Mixte de Recherche 1280 Physiologie des Adaptations Nutritionnelles, Department of Obstetrics and Gynecology, Centre d'Investigation Clinique Mère Enfant, Institut National de la Recherche Agronomique, University Hospital, Nantes, France
| | - D Subtil
- Department of Obstetrics and Gynecology, Jeanne de Flandre Hospital, Lille, France.,Pôle de Recherche et d'Enseignement Supérieur, University of Lille Nord de France, Lille, France
| | - F Goffinet
- Department of Obstetrics and Gynecology, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - G Kayem
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Research Center for Epidemiology and BioStatistics Sorbonne Paris Cité (CRESS), DHU Risks in pregnancy, Paris Descartes University, Paris, France.,Department of Obstetrics and Gynecology, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - N Resseguier
- EA 3279, CEReSS, Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - C Gire
- Department of Neonatology, North Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
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10
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Renal functional markers in extremely premature infants with and without twin-twin transfusion syndrome. J Perinatol 2020; 40:256-262. [PMID: 31616050 DOI: 10.1038/s41372-019-0524-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/25/2019] [Accepted: 09/27/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Describe renal function of preterm infants <29 weeks of gestational age (GA) with twin-twin transfusion syndrome (TTTS) who received laser therapy. DESIGN Retrospective analysis of premature TTTS compared with dichorionic-diamniotic (di-di) twins from 2006 to 2015. Primary outcome was biomarkers of renal injury. RESULTS Thirty-three TTTS-laser and 101 di-di newborns with similar GA at birth (26.4 ± 1.4 vs 26.9 ± 1.6 weeks, p = 0.07) were included. Creatinine and urea levels were higher in TTTS-laser group at day of life (DOL) 2-7 (123.5 ± 12.4 vs 75.8 ± 2 μmol/L, p = 0.0001 and 11.9 ± 1.1 mmol/L vs 8.7 ± 0.3 mmol/L, p = 0.0001) and DOL 8-14, (98.1 ± 14.2 vs 64.8 ± 2.3 μmol/L, p = 0.0001 and 9.1 ± 1.2 vs 5.4 ± 0.3 mmol/L, p = 0.0001). There was a significant effect of TTTS status on creatinine level at DOL 8-14. CONCLUSION In extremely preterm with TTTS treated by laser, biomarkers of renal function were higher compared with di-di twins in the first 2 weeks of life.
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11
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Park YH, Kim YN, Im DH, Kim DH, Byun JM, Jeong DH, Lee KB, Sung MS. Neonatal outcomes between discordant monochorionic and dichorionic twins. J Matern Fetal Neonatal Med 2019; 34:2080-2088. [PMID: 31416367 DOI: 10.1080/14767058.2019.1657085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study aimed to compare obstetrical complications and neonatal outcomes between monochorionic and dichorionic discordant twin pregnancies. STUDY DESIGN We enrolled 296 patients with twin pregnancy who delivered at Busan Paik Hospital between January 2014 and December 2017. The prevalence of obstetrical complications, neonatal mortality between monochorionic and dichorionic twins was compared. We also investigated whether there is a difference in neonatal outcome and neonatal morbidity between monochorionic discordant twins without monochorionic-specific complications and dichorionic discordant twins. RESULTS The risk of fetal death in utero (13.2 versus 5.2%, p = .025) and inter twin birth weight discordance (35.1 versus 20.8%, p = .031) is increased in monochorionic twins than in dichorionic twins. However, no difference was noted in obstetrical complication and neonatal mortality and morbidity between two groups. Among twin pregnancies with intertwin birth weight discordance, after excluding fetal death in utero and monochorionic specific complication, there was no difference in obstetrical complication and neonatal mortality and morbidity according to chorionicity. There was no difference in neonatal morbidity between monochorionic twins and dichorionic twins when comparing larger neonates and smaller neonates of each group. CONCLUSIONS Risk of birth weight discordance is higher in monochorionic twin but no significant difference was observed in maternal outcomes, neonatal mortality and morbidity between noncomplicated monochorionic and dichorionic discordant twins.
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Affiliation(s)
- Yong Hee Park
- Department of Obstetrics and Gynecology, Busan Paik Hospital, Busan, Republic of Korea
| | - Young Nam Kim
- Department of Obstetrics and Gynecology, Busan Paik Hospital, Busan, Republic of Korea.,Paik Institute for Clinical Research, Busan Paik Hospital, Inje University, Busan, Republic of Korea
| | - Do Hwa Im
- Department of Obstetrics and Gynecology, Busan Paik Hospital, Busan, Republic of Korea
| | - Da Hyun Kim
- Department of Obstetrics and Gynecology, Busan Paik Hospital, Busan, Republic of Korea
| | - Jung Mi Byun
- Department of Obstetrics and Gynecology, Busan Paik Hospital, Busan, Republic of Korea.,Paik Institute for Clinical Research, Busan Paik Hospital, Inje University, Busan, Republic of Korea
| | - Dae Hoon Jeong
- Department of Obstetrics and Gynecology, Busan Paik Hospital, Busan, Republic of Korea.,Paik Institute for Clinical Research, Busan Paik Hospital, Inje University, Busan, Republic of Korea
| | - Kyung Bok Lee
- Department of Obstetrics and Gynecology, Busan Paik Hospital, Busan, Republic of Korea
| | - Moon Su Sung
- Department of Obstetrics and Gynecology, Busan Paik Hospital, Busan, Republic of Korea.,Paik Institute for Clinical Research, Busan Paik Hospital, Inje University, Busan, Republic of Korea
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12
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Gheorghe CP, Boring N, Mann L, Donepudi R, Lopez SM, Chauhan SP, Bhandari V, Moise KJ, Johnson A, Papanna R. Neonatal Outcomes and Maternal Characteristics in Monochorionic Diamniotic Twin Pregnancies: Uncomplicated versus Twin-to-Twin Transfusion Syndrome Survivors after Fetoscopic Laser Surgery. Fetal Diagn Ther 2019; 47:165-170. [PMID: 31434071 DOI: 10.1159/000500858] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 05/09/2019] [Indexed: 11/19/2022]
Abstract
Preterm birth remains a major complication of fetal laser surgery (FLS) due to twin-to-twin transfusion syndrome (TTTS). OBJECTIVES We tested the hypothesis that neonatal outcomes in fetuses born at >24 weeks are worse in TTTS survivors compared to uncomplicated monochorionic diamniotic (MCDA) twins. METHODS 196 patients with TTTS treated with laser therapy and 91 uncomplicated MCDA gestations were compared. Neonatal outcomes included respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, and neonatal death. Risk factors assessed were TTTS, maternal age, maternal body mass index, race, premature prolonged rupture of membranes, stage of TTTS, parity, and gestational age (GA) at delivery. RESULTS GA at delivery was lower in the TTTS group (31.0 ± 4.6 vs. 33.5 ± 2.4 weeks, p < 0.001). RDS and TTN occurred at higher rates in the TTTS than in the uncomplicated MCDA group. After multivariate logistic regression, the only factor significantly associated with the composite adverse outcome was GA at delivery (OR 0.61; 95% CI: 0.58-0.7). CONCLUSION TTTS twins treated with FLS are deliver 2.5 weeks earlier than uncomplicated MCDA twins. Respiratory complications were significantly higher in TTTS twins and were mainly the consequence of the early GA at delivery.
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Affiliation(s)
- Ciprian P Gheorghe
- The Fetal Center, Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Noemi Boring
- The Fetal Center, Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Lovepreet Mann
- The Fetal Center, Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Roopali Donepudi
- The Fetal Center, Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Suzanne M Lopez
- Department of Pediatrics, McGovern Medical School - UTHealth, Houston, Texas, USA
| | - Suneet P Chauhan
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School - UTHealth, Houston, Texas, USA
| | - Vineet Bhandari
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Kenneth J Moise
- The Fetal Center, Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Anthony Johnson
- The Fetal Center, Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Ramesha Papanna
- The Fetal Center, Children's Memorial Hermann Hospital, Houston, Texas, USA,
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13
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The Impact of Selective Fetal Growth Restriction or Birth Weight Discordance on Long-Term Neurodevelopment in Monochorionic Twins: A Systematic Literature Review. J Clin Med 2019; 8:jcm8070944. [PMID: 31261823 PMCID: PMC6678939 DOI: 10.3390/jcm8070944] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 06/10/2019] [Accepted: 06/26/2019] [Indexed: 12/31/2022] Open
Abstract
The aim of this review was to assess the impact of selective fetal growth restriction (sFGR) and/or birth weight discordance (BWD) on long-term neurodevelopment in monochorionic (MC) twins. Five out of 28 articles assessed for eligibility were included. One article concluded that the incidence of long-term neurodevelopmental impairment (NDI) was higher in BWD MC twins (11/26, 42%) than in BWD dichorionic (DC) (5/38, 13%) and concordant MC twins (6/71, 8%). BWD MC twins had a 6-fold higher risk of cerebral palsy compared to DC twins (5/26, 19% vs. 1/40, 3%, p < 0.05). Another article described a linear relationship between birth weight and verbal IQ scores, demonstrating a 13-point difference for a 1000 gram BWD between the twins, with a disadvantage for the smaller twin (p < 0.0001). Three articles analyzing within-pair differences showed that the smaller twin more frequently demonstrated mild NDI (6/80, 8% vs. 1/111, 1%) and lower developmental test scores (up to 5.3 points) as opposed to its larger co-twin. Although these results suggest that MC twins with sFGR/BWD are at increased risk of long-term NDI as compared to BWD DC or concordant MC twins, with a within-pair disadvantage for the smaller twin, the overall level of evidence is of moderate quality. As only five articles with a high degree of heterogeneity were available, our review mainly demonstrates the current lack of knowledge of the long-term outcomes of MC twins with sFGR/BWD. Insight into long-term outcomes will lead to improved prognostics, which are essential in parent counseling and crucial in the process of forming a management protocol specifically for twins with sFGR to optimally monitor and support their development.
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14
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Sommer J, Nuyt AM, Audibert F, Dorval V, Wavrant S, Altit G, Lapointe A. Outcomes of extremely premature infants with twin-twin transfusion syndrome treated by laser therapy. J Perinatol 2018; 38:1548-1555. [PMID: 30177860 DOI: 10.1038/s41372-018-0202-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 07/03/2018] [Accepted: 07/17/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare short-term and long-term outcomes of preterm infants born at <29 weeks of gestational age (GA) with twin-twin transfusion syndrome (TTTS) treated with laser therapy to preterm twin infants without TTTS. DESIGN Retrospective case-control study comparing 33 preterm TTTS twins to 101 preterm diamniotic-dichorionic (di-di) twins born at our institution between 2006 and 2015. RESULTS GA at birth were 26.4 ± 1.4 weeks (TTTS) and 26.9 ± 1.6 weeks (di-di) (p = 0.07). TTTS premature newborns were less exposed to antenatal steroids (p = 0.01), more frequently born by C-section (p = 0.005), received more surfactant therapy (p = 0.004, and were smaller for GA (p < 0.001). When adjusted for antenatal steroids and birth weight, TTTS status was not associated with increased mortality (HR 1.66, 95% CI 0.77-3.56, p = 0.20). No differences were found on neurodevelopmental outcomes at 18 months of corrected GA. CONCLUSION Premature TTTS newborns treated with fetal laser therapy had similar survival and neurodevelopmental outcomes compared to preterm di-di twins without TTTS.
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Affiliation(s)
- Julie Sommer
- Department of Pediatrics, Division of Neonatology, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Anne-Monique Nuyt
- Department of Pediatrics, Division of Neonatology, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - François Audibert
- Department of Obstretrics and Gynecology, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Véronique Dorval
- Department of Pediatrics, Division of Neonatology, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Sandrine Wavrant
- Department of Obstretrics and Gynecology, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Gabriel Altit
- Department of Pediatrics, Division of Neonatology, Montreal Children's Hospital, McGill University, Montréal, QC, Canada
| | - Anie Lapointe
- Department of Pediatrics, Division of Neonatology, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada.
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15
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Sundaram V, Ribeiro S, Noel M. Multi-chorionic pregnancies following single embryo transfer at the blastocyst stage: a case series and review of the literature. J Assist Reprod Genet 2018; 35:2109-2117. [PMID: 30362060 DOI: 10.1007/s10815-018-1329-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 10/02/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To report cases of in vitro fertilization-frozen embryo transfer (IVF-FET) with single blastocyst transfer resulting in di- or tri-chorionic pregnancies, and to review the literature on monozygotic, multi-chorionic pregnancies originating at the blastocyst stage. DESIGN Retrospective case series and literature review. MATERIALS AND METHODS All in vitro fertilization cycles (fresh, frozen, autologous, and donor oocyte) performed between June 2012 and June 2017 at the University of California, San Francisco Center for Reproductive Health, were reviewed retrospectively. Cycles with cleavage-stage embryos or transfer of more than one blastocyst were excluded. Cycles were analyzed to determine if clinical pregnancy occurred with the presence of two or more gestational sacs noted on initial ultrasound. An in-depth chart review was performed with further exclusions applied that would lend credence to dizygosity rather than monozygosity such as fetal/neonatal sex discordance, fresh embryo transfer, and natural cycle FET (in which concomitant spontaneous pregnancy could have occurred). Demographic, clinical and IVF-FET cycle characteristics of the resulting patients were collected. Additionally, a review of the English language literature was performed (PUBMED, PMC) using the search words monozygotic twins, dichorionic diamniotic, in vitro fertilization, and single embryo transfer in order to identify cases of DC-DA monozygotic twinning from 1978 to 2017. Resulting articles were reviewed to eliminate all cases of dizygosity and day 3 embryo transfers. We obtained the following data from the literature search: basic patient demographics, type of fertilization, type and day of embryo transferred, number of embryos transferred, gestational ultrasound details, presence of any genetic testing if performed after delivery, and number of live births. RESULT(S) Two thousand four hundred thirty-four women underwent fresh or frozen single embryo transfer between June 2012 and June 2017 at the University of California, San Francisco Center for Reproductive Health. Of these, 11 women underwent a single blastocyst transfer with subsequent clinical pregnancies identified as multi-chorionic gestations. Four were in downregulated controlled FET cycles, in which concomitant spontaneous pregnancy could not have been possible. We then reviewed all cases of monozygotic dichorionic-diamniotic (DC-DA) splitting in IVF patients reported in the literature from 1978 to 2017. These eight cases demonstrate monozygotic splitting after the blastocyst stage, which challenges the existing dogma that only monochorionic twins can develop after day 3 post-fertilization. CONCLUSION(S) The accepted theory of monozygotic twinning resulting from the splitting of an embryo per a strict post-fertilization timing protocol must be re-examined with the advent of observed multi-chorionic pregnancies resulting from single blastocyst transfer in the context of IVF.
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Affiliation(s)
- Viji Sundaram
- University of California, San Francisco, 499 Illinois St, San Francisco, CA, 94158, USA.
| | - Salustiano Ribeiro
- University of California, San Francisco, 499 Illinois St, San Francisco, CA, 94158, USA
| | - Martha Noel
- University of California, San Francisco, 499 Illinois St, San Francisco, CA, 94158, USA
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16
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Townsend R, Khalil A. Fetal growth restriction in twins. Best Pract Res Clin Obstet Gynaecol 2018; 49:79-88. [DOI: 10.1016/j.bpobgyn.2018.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 02/15/2018] [Indexed: 12/12/2022]
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