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Yum SK, Lee JH. Role of birthweight discordance in preterm twins' outcomes in the Korean neonatal network. Pediatr Neonatol 2023; 64:570-576. [PMID: 36967292 DOI: 10.1016/j.pedneo.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/28/2022] [Accepted: 12/08/2022] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Twin pregnancies can be complicated by birthweight (BW) discordance. We analyzed the impact of BW discordance on clinical outcomes of very-low-birthweight (VLBW) twins. METHODS The study population was preterm infants in the Korean Neonatal Network registry. Multivariate logistic regression analyses were used to determine the contribution of BW discordance on respiratory morbidities and mortality of VLBW infants. Also, we assessed the effect of small for gestational age (SGA) on morbidity and mortality in discordant twins (DTs) and compared separately the clinical outcomes of smaller and larger DTs with different singletons matched for perinatal factors including BW percentile. RESULTS A total of 935 twin pairs [1548 concordant twins (CTs) and 322 DTs] were included. BW discordance was associated with increased odds of moderate bronchopulmonary dysplasia, mortality, and composite outcomes. Compared with the CTs, the smaller, but not larger, DTs had greater odds of morbidities and mortality. DTs had higher odds of adverse neonatal outcome when combined with SGA. Meanwhile, DTs had morbidities and mortality similar to singletons matched for BW percentile. CONCLUSION BW discordance in VLBW twins adversely affects neonatal mortality or respiratory morbidity which is predominant in smaller DTs. The impact of BW discordance could be increased through SGA.
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Affiliation(s)
- Sook Kyung Yum
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, South Korea
| | - Jung Hyun Lee
- Department of Pediatrics, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, South Korea.
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2
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Ylilehto E, Palomäki O, Korhonen P, Huhtala H, Uotila J. Impact of mode of delivery on perinatal outcome in moderately and late preterm twin birth. Int J Gynaecol Obstet 2020; 153:106-112. [PMID: 33040352 DOI: 10.1002/ijgo.13418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/05/2020] [Accepted: 10/08/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine the impact of the mode of delivery on neonatal and maternal outcomes in moderately and late preterm twin birth. METHODS This single-center cohort study included 275 live diamniotic moderately and late preterm twin deliveries at 32+0 -36+6 weeks of gestation. These twin deliveries were divided into two groups according to the planned mode of delivery: trial of labor (TOL) (N=199, 72.4%) and planned cesarean section (CS) (N=76, 27.6%). The primary outcome was neonatal morbidity. Maternal outcome and the effects of gestational age and chorionicity on neonatal outcome were also studied. RESULTS Of the women in the TOL group, 170 (85.4%) delivered vaginally. Both for the first and second twin, and for dichorionic or monochorionic deliveries, there were no differences between the TOL and CS groups in composite neonatal morbidity or in other neonatal outcomes. No significant differences were found between the TOL and CS groups when the moderately and late preterm gestational age cohorts were studied separately. Mothers in the planned CS group more often had puerperal infection and surgical complications in comparison with mothers in the TOL group. CONCLUSION Among 275 moderately and late preterm twin deliveries, planned mode of delivery did not affect neonatal outcome.
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Affiliation(s)
- Elina Ylilehto
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Outi Palomäki
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Päivi Korhonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Jukka Uotila
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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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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Neurodevelopmental outcome of preterm twins at 5 years of age. Pediatr Res 2020; 87:1072-1080. [PMID: 31830757 DOI: 10.1038/s41390-019-0688-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 09/26/2019] [Accepted: 11/11/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Twins are considered to be at an increased risk for perinatal mortality and morbidities, but it is unclear whether preterm twins are at an increased risk for poor developmental outcomes when compared to preterm singletons. Our aim was to compare the neurodevelopmental outcome of preterm twins vs singletons at 5 years of age. METHODS Very low birth weight and very low gestational age infants (twins n = 66, singletons n = 157) were recruited as a part of the PIPARI project in the Turku University Hospital, covering a regional population. Cognitive development, neuropsychological performance, and neurodevelopmental impairments (including cerebral palsy, hearing deficit, visual impairment, and intellectual disability) were evaluated at 5 years of age. RESULTS Twins and singletons had otherwise similar perinatal background factors, except for the higher proportion of preterm rupture of membranes in singletons. Twins had cognitive and neuropsychological outcomes that were otherwise comparable with singletons, but they had a slightly lower verbal intelligence quotient (estimate -5.81, 95% CI -11.14 to -0.48, p = 0.03). Being a twin was not a risk for neurodevelopmental impairments. CONCLUSIONS Our study shows that, contrary to a common hypothesis, the overall neurodevelopment of very preterm twins does not significantly differ from that of preterm singletons.
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Changes in the perinatal outcomes of twin pregnancies delivered at a tertiary referral center in Korea during a 24-year period from 1995 to 2018. Obstet Gynecol Sci 2020; 63:251-260. [PMID: 32489969 PMCID: PMC7231938 DOI: 10.5468/ogs.2020.63.3.251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/24/2019] [Accepted: 10/04/2019] [Indexed: 11/15/2022] Open
Abstract
Objective To analyze the changes in the clinical characteristics and perinatal outcomes of twin pregnancies delivered at a tertiary referral center in Korea during a 24-year period. Methods This was a retrospective cohort study of twin pregnancies delivered at 24–40 weeks of gestation, from 1995 to 2018. The subjects were divided into 4 groups according to the year of delivery: 1995–2000, 2001–2006, 2007–2012, and 2013–2018. The trends in the changes in the twin birth rate, maternal age, assisted reproductive technology (ART) pregnancy rate, chorionicity, obstetric complications, delivery outcomes, and neonatal outcomes over the periods were analyzed. Results A total of 2,133 twin pregnancies were included in the study. The twin birth rate increased from 16.7/1,000 in 1995–2000 to 42.2/1,000 in 2001–2006, 49.5/1,000 in 2007–2012, and 61.8/1,000 in 2013–2018. The maternal age and ART pregnancy and dichorionic twin rates increased, while the monochorionic twin rate decreased over the periods. The incidence of fetal congenital anomalies, cervical incompetence, gestational diabetes mellitus, preeclampsia, and placental abruption increased over the periods. The preterm birth (PTB) rate significantly decreased owing to the decreasing elective late-PTB rate; however, the early-PTB rate significantly increased. Conclusion This study found that twin pregnancies increased steadily over the last 24 years and that the increase was related to increased maternal age and ART pregnancy rate. The incidence of obstetric complications increased over the periods; however, the neonatal intensive care unit admission rate decreased, along with decreases in the elective late-PTB rate.
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The value of ultrasound in predicting isolated inter-twin discordance and adverse perinatal outcomes. Arch Gynecol Obstet 2018; 299:459-468. [PMID: 30564927 DOI: 10.1007/s00404-018-5002-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To investigate the value of ultrasound approaching delivery to predict isolated inter-twin discordance and adverse perinatal outcomes. METHODS We retrospectively included twin pregnancies with sonography approaching delivery in ten maternal-foetal medicine centres in China from 2013 to 2014. Estimated foetal weight (EFW) and inter-twin EFW disparity (EFWD) were calculated based on biometry parameters. Percentage errors between EFW and actual birthweight or between EFWD and actual inter-twin disparity were calculated. ROC curves and multiple logistic regression were applied to evaluate the ability of EFWD to predict inter-twin disparity ≥ 25%, stillbirth, asphyxia and admission to a neonatal intensive unit (NICU). Chorionicity-stratified analysis was further performed. RESULTS Two hundred sixty-six monochorionic and 760 dichorionic twin pregnancies were analysed. The percentage errors in foetal weight estimations were 7-13%, whereas percentage errors in the estimation of inter-twin disparity were nearly 100%. Among eight formulas, Hadlock1 performed best, with a detectable rate of 65% and a false positive rate of 5% when predicting inter-twin disparity ≥ 25%. EFWD ≥ 22% was strongly associated with stillbirth (OR = 4.17, 95% CI 1.40-12.40) and NICU admission (OR = 3.48, 95% CI 2.03-5.97) after adjustment for gestational age, parity and abnormal umbilical systolic/diastolic ratio. Ultrasound had better predictive ability in monochorionic twins. CONCLUSION The predictive value of ultrasound for isolated inter-twin discordance and adverse perinatal outcomes was limited, which was possibly due to the magnifying of systematic errors in the disparity estimation compared with weight estimation. Despite this, abnormal biometry was an independent contributor for the poor prognosis of neonates.
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Bracero LA, Huff C, Blitz MJ, Plata MJ, Seybold DJ, Broce M. Ultrasound and histological measurements of dividing membrane thickness in twin gestations. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:470-475. [PMID: 27790818 DOI: 10.1002/uog.17337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/08/2016] [Accepted: 10/16/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To determine how prenatal ultrasound measurements of dividing membrane thickness correlate with postnatal histological measurements and chorionicity in twin gestations. METHODS This was a prospective, longitudinal cohort study of twin gestations. Dividing membrane thickness was measured by transabdominal ultrasound, with the insonation beam both parallel and perpendicular to the membrane, in the second or third trimester, depending on when care was established. Ultrasound examinations were performed every 4 weeks following initial assessment until delivery. Measurements of membrane thickness from the first ultrasound examination were compared with histological measurements after delivery. RESULTS A total of 45 twin pregnancies (32 dichorionic, 13 monochorionic) were included. Mean gestational age at initial ultrasound examination was 24.1 ± 7.3 weeks. Parallel ultrasound measurements of membrane thickness were 1.6 ± 0.8 mm for monochorionic and 2.5 ± 0.9 mm for dichorionic gestations (P = 0.001). Perpendicular ultrasound measurements were 1.6 ± 0.3 mm for monochorionic and 2.2 ± 0.8 mm for dichorionic gestations (P = 0.009). Inter- and intraobserver reliability of ultrasound measurements were 0.847 and 0.950, respectively. Parallel and perpendicular ultrasound measurements correlated better with each other (R = 0.807, P < 0.001) than with histological measurements of membrane thickness (Rparallel = 0.538, P < 0.001; Rperpendicular = 0.529, P < 0.001). Receiver-operating characteristics curve analyses to predict histological membrane thickness > 50th percentile resulted in an area under the curve (AUC) of 0.828 for parallel (P < 0.001) and 0.874 for perpendicular (P < 0.001) measurements with a cut-off value of 1.9 mm for both approaches. The AUCs for parallel and perpendicular measurements to predict dichorionicity were 0.892 (P < 0.001) and 0.823 (P < 0.001) with cut-off values of 1.9 and 1.8 mm, respectively. CONCLUSION Prenatal ultrasound measurement of twin dividing membrane thickness is positively correlated with postnatal histological measurement. Dichorionicity can be determined by a magnified dividing membrane thickness ≥ 1.9 mm. Measurements with the ultrasound beam parallel to the dividing membrane may be more accurate than perpendicular measurements. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- L A Bracero
- Department of Obstetrics and Gynecology, West Virginia University Charleston Campus, Charleston, WV, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hofstra Northwell School of Medicine, Southside Hospital, Bay Shore, NY, USA
| | - C Huff
- Department of Obstetrics and Gynecology, West Virginia University Charleston Campus, Charleston, WV, USA
| | - M J Blitz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hofstra Northwell School of Medicine, North Shore University Hospital, Manhasset, NY, USA
| | - M J Plata
- Department of Pathology, Charleston Area Medical Center, Charleston, WV, USA
| | - D J Seybold
- Center for Health Services & Outcomes Research, Charleston Area Medical Center, Charleston, WV, USA
| | - M Broce
- Center for Health Services & Outcomes Research, Charleston Area Medical Center, Charleston, WV, USA
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Aksam S, Plesinac S, Dotlic J, Tadic J, Vrzic-Petronijevic S, Petronijevic M, Kocijancic-Belovic D, Buzadzic S. First trimester ultrasonographic parameters in prediction of the course and outcome of monochorionic twin pregnancies. Turk J Med Sci 2017; 47:934-941. [PMID: 28618747 DOI: 10.3906/sag-1607-16] [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: 07/04/2016] [Accepted: 02/19/2017] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM The aim of the study was to evaluate the association and the potential predictive value of first trimester ultrasonographic parameters on the course and outcome of monochorionic diamniotic twin pregnancies. MATERIALS AND METHODS A prospective cohort study was undertaken of 39 healthy women with consecutive monochorionic diamniotic twin pregnancies. During first-trimester screening, crown-rump length (CRL) and nuchal translucency (NT) were measured. The intertwin discordance in CRL and NT was determined. As pregnancy outcomes we assessed twins' live-born rates, Apgar scores, birth weight, pregnancy complications, and gestational week of delivery. RESULTS None of the assessed pregnancy outcomes significantly correlated with standard CRL discordance ≥10%. The newly established cut-off was 3.75 mm for CRL and 1.3 mm for NT. Monochorionic diamniotic twins were delivered in a later gestational week and had better chance of survival if CRL intertwin difference was <3.75 mm. Apgar scores significantly negatively correlated only with NT of corresponding twins. When intertwin NT difference was ≥1.3 mm, twins had lower birth weight and pregnancy complications were more frequent. Regression models show that intertwin CRL difference <3.75 mm is a significant predictor of live-born monochorionic diamniotic twins. CONCLUSION CRL and NT in monochorionic diamniotic twin pregnancies could indicate pregnancy complications and outcomes.
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Affiliation(s)
- Slavica Aksam
- Clinic of Obstetrics and Gynecology, Clinical Center of Serbia, Belgrade, Serbia
| | - Snezana Plesinac
- Clinic of Obstetrics and Gynecology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Dotlic
- Clinic of Obstetrics and Gynecology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jasmina Tadic
- Clinic of Obstetrics and Gynecology, Department of Pathology, Clinical Center of Serbia, Belgrade, Serbia
| | - Svetlana Vrzic-Petronijevic
- Clinic of Obstetrics and Gynecology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milos Petronijevic
- Clinic of Obstetrics and Gynecology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Snezana Buzadzic
- Clinic of Obstetrics and Gynecology, Clinical Center of Serbia, Belgrade, Serbia
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Braun T, Weichert A, Gil HC, Sloboda DM, Tutschek B, Harder T, Dudenhausen JW, Plagemann A, Henrich W. Fetal and neonatal outcomes after term and preterm delivery following betamethasone administration in twin pregnancies. Int J Gynaecol Obstet 2016; 134:329-35. [DOI: 10.1016/j.ijgo.2016.02.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/29/2016] [Accepted: 05/13/2016] [Indexed: 11/30/2022]
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Abstract
The aim of the present work was to determine maternal and fetal outcomes of intrahepatic cholestasis of pregnancy (ICP) in twin pregnancies. All twin pregnancies delivered above 28 gestational weeks in West China Second University Hospital from January 2013 to May 2015 were included. Data on maternal demographics and obstetric complications together with fetal outcomes were collected. The risk of adverse maternal and fetal outcomes were determined in relation to ICP by crude odds ratios (OR) and adjusted ORs (aOR) with 95% confidence intervals (CI). Subgroup analysis concentrated on the effect of assisted reproductive technology (ART), ICP severity, and onset time. A total of 1,472 twin pregnancies were included, of which 362 were cholestasis patients and 677 were conceived by ART. Higher rates of preeclampsia (aOR 1.96; 95% CI 1.35, 2.85), meconium-stained amniotic fluid (aOR 3.10; 95% CI 2.10, 4.61), and preterm deliveries (aOR 3.20; 95% CI 2.35, 4.37) were observed in ICP patients. Subgroup analysis revealed higher incidences of adverse outcomes in severe and early onset ICP groups. In conclusion, adverse maternal and fetal outcomes were strongly associated with ICP in twin patients. Active management and close antenatal monitoring are needed, especially in the early onset and severe groups.
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Mayeur Le Bras A, Petit F, Benachi A, Bedel B, Oucherif S, Martinovic J, Armanet N, Tosca L, Gautier V, Parisot F, Labrune P, Tachdjian G, Brisset S. Confined blood chimerism in a monochorionic dizygotic sex discordant twin pregnancy conceived after induced ovulation. ACTA ACUST UNITED AC 2016; 106:298-303. [DOI: 10.1002/bdra.23457] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 07/31/2015] [Accepted: 09/04/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Anne Mayeur Le Bras
- Service d'Histologie Embryologie et Cytogénétique; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - François Petit
- Laboratoire de Génétique Moléculaire; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Alexandra Benachi
- Service de Gynécologie-Obstétrique; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Bettina Bedel
- Service de Gynécologie-Obstétrique; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Salima Oucherif
- Service de Néonatalogie; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Jelena Martinovic
- Unité de Fœtopathologie; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Narjes Armanet
- Service d'Histologie Embryologie et Cytogénétique; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Lucie Tosca
- Service d'Histologie Embryologie et Cytogénétique; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Valérie Gautier
- Service d'Histologie Embryologie et Cytogénétique; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Frédéric Parisot
- Service d'Histologie Embryologie et Cytogénétique; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Philippe Labrune
- Service de Pédiatrie; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Gérard Tachdjian
- Service d'Histologie Embryologie et Cytogénétique; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Sophie Brisset
- Service d'Histologie Embryologie et Cytogénétique; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
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12
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Korček P, Straňák Z. Fetal distress and circulatory disturbance in monochorionic twins: Possible risk factors for sialadenitis? Int J Pediatr Otorhinolaryngol 2015; 79:2476-8. [PMID: 26590003 DOI: 10.1016/j.ijporl.2015.10.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/25/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
Abstract
Neonatal sialadenitis is a rare condition. The vast majority of cases are caused by Staphylococcus aureus with predominant involvement of the parotid gland and need for long-term antimicrobial therapy. We reviewed three distinct cases of submandibular sialadenitis in preterm infants from monochorionic pregnancies. The association with neonatal sialadenitis is unproven. We speculate about the role of fetal distress and circulatory compromise in monochorionic twins as a risk factor in the development of this serious condition.
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Affiliation(s)
- Peter Korček
- Institute for the Care of Mother and Child, Fetal Medicine Center, Podolské nábreží 157, 14700 Prague, Czech Republic; Third Faculty of Medicine, Charles University, Ruská 87, 10000 Prague, Czech Republic
| | - Zbyněk Straňák
- Institute for the Care of Mother and Child, Fetal Medicine Center, Podolské nábreží 157, 14700 Prague, Czech Republic; Third Faculty of Medicine, Charles University, Ruská 87, 10000 Prague, Czech Republic.
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13
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Carter EB, Bishop KC, Goetzinger KR, Tuuli MG, Cahill AG. The impact of chorionicity on maternal pregnancy outcomes. Am J Obstet Gynecol 2015; 213:390.e1-7. [PMID: 25986034 DOI: 10.1016/j.ajog.2015.05.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/27/2015] [Accepted: 05/13/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Women carrying twin pregnancies often receive similar counseling, regardless of chorionicity, with the notable exception of twin-twin transfusion syndrome (TTTS); however, little is known about whether the presence of 1 vs 2 placentas confers dissimilar maternal risks. We sought to determine differences in maternal and neonatal outcomes based on chorionicity. STUDY DESIGN This was a retrospective cohort study of all twin pregnancies at our institution undergoing routine second-trimester ultrasound for anatomic survey from 1990 through 2010. Secondary outcomes included other adverse maternal and neonatal outcomes. Relative risks and adjusted odds ratios (aORs) were calculated. Cluster analysis was used to account for nonindependence of twin pairs. RESULTS Of 2301 pregnancies, 1747 (75.9%) were dichorionic and 554 (24.1%) were monochorionic. Rates of preeclampsia, gestational diabetes, placental abruption, placenta previa, preterm labor, and preterm premature rupture of membranes (PPROM) were not significantly different in dichorionic vs monochorionic pregnancies. Early preterm delivery less than 34 weeks (aOR, 1.47; 95% confidence interval [CI], 1.17-1.86) and less than 28 weeks (aOR, 2.58; 95% CI, 1.58-4.20) were more likely in monochorionic twins, as was neonatal intensive care unit admission (aOR, 1.41; 95% CI, 1.12-1.78). Monochorionic twins delivered earlier at a mean gestational age of 34.2 weeks vs 35.0 weeks for dichorionic twins (P < .001). Hospital length of stay was significantly longer for monochorionic twins with a mean of 13.7 days vs 10.8 days for dichorionic twins (P = .01). CONCLUSION There are no significant differences in maternal outcomes by chorionicity; however, monochorionicity is associated with increased fetal risks. This information may be helpful in guiding more targeted counseling to expectant parents of twins that, although the presence of an additional placenta does not confer additional maternal risks, monochorionic infants tend to deliver earlier and require longer hospital stays.
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Affiliation(s)
- Ebony B Carter
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO.
| | - Katherine C Bishop
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO
| | - Katherine R Goetzinger
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO
| | - Methodius G Tuuli
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO
| | - Alison G Cahill
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO
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