Retrospective analysis of monochorionic twin pregnancies born in the Institute for the Care of Mother and Child between 2012–2015
Authors:
K. Běhávková 1; L. Krofta 1,2; K. Macková 1; J. Vojtěch 1; L. Hašlík 1; R. Pock 1; L. Hympánová 1; M. Kučerová 1; H. Heřman 1; Z. Straňák 1,2; J. Feyereisl 1,2,3
Authors place of work:
Ústav pro péči o matku a dítě, Praha, ředitel doc. MUDr. J. Feyereisl, CSc.
1; 3. lékařská fakulta Univerzity Karlovy, Praha
2; Katedra gynekologie a porodnictví IPVZ, Praha
3
Published in the journal:
Ceska Gynekol 2017; 82(3): 180-189
Summary
Objective:
The purpose of this study was to describe monochorionic twin pregnancies and their complications, born between 24th and 37th week of gestation in the Institute for the Care of Mother and Child in years 2012–2015.
Design:
Retrospective cohort.
Setting:
The Institute for the Care of Mother and Child, Praha.
Methods:
From 2012 to 2015 we observed 177 monochorionic twin pregnancies from which two or one viable fetuses were born, or both fetuses died in utero.
Results:
From a total of 177 women, 12 (6.8%) gave birth before 26th week of gestation, between 26+0 – 27+6 four women (2.3%) gave birth, 37 women (20.9%) between 28+0 – 31+6, 84 women (47.8%) between 32+0 – 35+6 and after 36th week of gestation 40 women (22.6%) gave birth. Mean week of delivery was 33.8.
Indications for termination of pregnancies were premature rupture of membranes (PPROM) in 11.9%, onset of spontaneus uterine contractions in 12.4% and in 53.3% other iatrogenic indication. 23.3% of pregnancies in our cohort were uncomplicated and terminated after 36th week of gestation.
We performed caesarean section in 94.3%, in 5.7% patients gave birth vaginally.
In vitro fertilization had 19.9% women, 80.1% conceived spontaneously.
The age range of pregnant women in our cohort was 20–43, with median 32.3.
Mean weight of bigger fetus was 2047.6 g (min. 520 g, max. 3530 g), mean weight of smaller fetus was 1799.5 g (min. 350 g, max. 2790 g).
In 30 cases (16. 9%) we performed intrauterine intervetion. In 21/30 cases (11.9%) for TTTS diagnose, in 5/30 cases (2.8%) for congenital abnormalities or TRAP sequence and in 4/30 cases (2.2%) for sIUGR type III.
The most frequent complication in our cohort was sIUGR (36 patients – 20.3%), TTTS (21 patients – 11.9%) and on the third place congenital abnormality or TRAP sequence (five patients – 2.8%)
Nineteen patients gave birth to one viable fetus, in two cases both fetuses died in utero. In one case, in twin pair, one new-born died shortly after the birth – it had several congenital abnormalities and due to anhydramnion it was impossible to perform amnioinfusion and umbilical cord occlusion. After the birth it was given palliative care.
Conclusion:
The study brought data about specific risks in monochorionic twin pregnancies and suggests careful observation of women in fixed intervals and necessity of immediate referral to perinatal centre in case of any suspicious or pathological finding.
Keywords:
monochorionic pregnancies, transfusion syndrome, growth restriction
Zdroje
1. Acosta-Rojas, R., Becker, J., Munoz-Abellana, B., et al. Twin chorionicity and the risk of adverse perinatal outcome. Int J Gynaecol Obstet, 2007, 104, p. 1203–1207.
2. Ananth, VA., Chauhan, SP. Epidemiology of twinning in developer countries. Semin Perinatol, 2012, 36, p. 156–161.
3. Baldwin, VJ. Anomalous development of twins. Pathology of multiple pregnancy. Springer US, 1994, p. 169–197.
4. Barigye, O., Pasquini, L., Galea, P., et al. High risk of unexpected late fetal death in monochorionic twins despite intensiti ultrasound surveillance: a cohort study. PLoS Med, 2005, 2:e172.
5. Berghella, V., Kaufmann, M. Natural history of twin-twin transfusion syndrome. J Reprod Med, 2001, 46, p. 480–484.
6. Denbow, ML., Cox, P., Taylor, M., et al. Placental angioarchitecture in monochorionic twin pregnancies: relationship to fetal growth, fetofetal transfusion syndrome, and pregnancy outcome. AJOG, 2000, 182, p. 417–426.
7. Gratacos, E., Lewi, L., Munoz, B., et al. A classification system for selective intrauterine growth restriction in monochorionic pregnancies according to umbilical artery doppler flow in the smaller twin. Ultrasound Obstet Gynecol, 2007, 30, p. 28–34.
8. Khalil, A., D´Antonio, F., Dias, T., et al. Southwest Thames Obstetric Research Collaborative (STORK). Ultrasound estimation of birth weight in twin pregnancy: comparison of biometry algorithms in the STORK mutiple pregnancy cohort. Ultrasound Obstet Gynecol, 2014, 44, p. 210–220.
9. Kulkarni, AD., Kissin, DM., Adashi, EY. Fertility treatments and multiple births in the United States. NEJM, 2014, 370, p. 1070–1071.
10. Lambalk, CB., Boomsma, D., DeBoer, L. Increased levels and pulsatility of follicle-stimulating hormone in mothers of hereditary dizygotic twins. J Clin Endocrynol Metab, 1998, 83, p. 481–486.
11. Lewi, L., Gratacos, E., Ortibus, E., et al. Pregnancy and infant outcome of 80 consecutive cord coagulations in complicated monochorionic multiple pregnancies. AJOG, 2006, 194, p. 782–789.
12. Lewi, L., Jani, J., Blickstein, I., et al. The outcome of monochorionic diamniotic twin gestations in the era of invasive fetal therapy: a prospective cohort study. AJOG, 2008, 199, p. 514.e1–514.e8.
13. Lewi, L., Van Schoubroecka, D., Gratacos, E., et al. Monochorionic diamniotic twins: complications and management options. Curr opin Obstet Gynecol, 2003, 15, p. 177–194.
14. Lopriore, E., Lewi, L., Oepkes, D., et al. In utero acquired limb ischemia in monochorionic twins with and without twin-to-twin transfusion syndrome. Prenat Diagn, 2008, 28, p. 800–804.
15. Machin, GA. Some causes of genotypic discordance in monozygotic twin pairs. Am J Med Genet, 1996, 61, p. 216–228.
16. Moldenhauer, MD., Johnson, MP. Diagnosis and management of complicated monochorionic twins, Perelman School of Medicine, University of Pennsylvania; and Center for Fetal Diagnosis and Treatment, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania.
17. Ortibus, E., Lopriore, E., Deprest, J., et al. The pregnancy and long-term neurodevelopmental outcome of monochorionic diamniotic twin gestations: a multicenter prospective cohort study from the first trimester onward. AJOG, 2009, 200, p. 494. e1–494.e8.
18. Quarello, E., Molho, M., Ville, Y. Incidence, mechanisms, and patterns of fetal cerebral lesions in twin-to-twin transfusion syndrome. J Matern Fetal Neonatal Med, 2007, p. 589–597.
19. Quintero, RA., Morales, WJ., Allen, MH., et al. Staging of twin-twin transfusion syndrome. J Perinatol, 1999, 19, p. 550–555.
20. Roby, R., Lewi, L., Salomon, LJ., et al. Prevalence and management of late fetal complications following successful selective lasercoagulation of chorionic plate anastomoses in twin-to-twin transfusion syndrome. AJOG, 2006, 194, p. 796–803.
21. Schrey, S., Huber, A., Hecher, K., et al. Vascular limb occlusion in twin-twin transfusion syndrome (TTTS): case series and literature review. AJOG, 2012, 207, p. 131.e1–10.
22. Sebire, NJ., Snijders, RJ., Hughes, K., et al. The hidden mortality of monochorionic twin pregnancies. Br J Obstet Gynecol, 1997, 104, p. 1203–1207.
23. Senat, MV., Deprest, J., Boulvain, M., et al. Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. N Engl J Med, 2004, 351, p. 136–144.
24. Simoes, T., Amaral, N., Lerman, R., et al. Prospective risk of intrauterine death of monochorionic-diamniotic twins. AJOG, 2006, 195, p. 134–139.
25. Sobek, JR. High incidence of monozygotic twinning after assisted reproduction is related to genetic information, but not to assisted reproduction technology itself. Fertil Steril, 2015, 103, p. 756–760.
26. Sperling, L., Kiil, C., Larsen, LU., et al. Detection of chromosomal abnormalities, congenital abnormalities and transfusion syndrome in twins. Ultrasound Obstet Gynecol, 2007, 29, p. 517–526.
27. The ESHRE Capri Workshop Group. Multiple gestation pregnancy. Hum Reprod, 2000, 15, p. 1856–1864.
28. Vitthala, S., Gelbaya, TA., Bricon, DR., et al. The risk of monozygotic twins after assisted reproductive technology: a systematic review and meta-analysis. Hum Reprod, Update, 2009, 15, p. 45–55.
Štítky
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicineČlánok vyšiel v časopise
Czech Gynaecology
2017 Číslo 3
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