Abstract
Monochronioric (MC) twin pregnancies are considered as high-risk pregnancies with potential complications requiring in-utero interventions. We aimed to assess prenatal attachment, anxiety, post-traumatic stress disorder (PTSD) and depressive symptoms in MC pregnancies complicated with Twin-To-Twin-transfusion syndrome (TTTS) in comparison to uncomplicated monochorionic (UMC) and dichorionic pregnancies (DC). Auto-questionnaires were filled out at diagnosis of TTTS and at successive milestones. Prenatal attachment, PTSD, anxiety and perinatal depression were evaluated respectively by the Prenatal Attachment Inventory (PAI) completed for each twin, the Post-traumatic Checklist Scale (PCLS), the State-Trait Anxiety Inventory (STAI) and the Edinburgh Perinatal Depression Scale (EPDS). There was no significant difference in the PAI scores between the two twins. In the DC and UMC groups, PAI scores increased throughout pregnancy, whilst it didn’t for TTTS group. TTTS and DC had a similar prenatal attachment while MC mothers expressed a significantly higher attachment to their fetuses and expressed it earlier. At the announcement of TTTS, 72% of the patients present a score over the threshold at the EPDS Scale, with a higher score for TTTS than for DC (p = 0.005), and UMC (p = 0.007) at the same GA. 30% of mothers in TTTS group have PTSD during pregnancy. 50% of TTTS- patients present an anxiety score over the threshold (STAI-Scale), with a score significantly higher in TTTS than in UMC (p<0.001) or DC (p<0.001). The proportion of subject with a STAI–State over the threshold is also significantly higher in TTTS than in DC at 20 GW (p = 0.01) and at 26 GW (p<0.05). The STAI-state scores in UMC and DC increase progressively during pregnancy while they decrease significantly in TTTS. TTTS announcement constitutes a traumatic event during a pregnancy with an important risk of PTSD, high level of anxiety and an alteration of the prenatal attachment. These results should guide the psychological support provided to these patients.
Highlights
Monochorionic (MC) twin pregnancies represent 20–25% of all twin pregnancies with a continuously increasing incidence [1] [2]
Of the 23 subjects included in the study for to-twin transfusion syndrome (TTTS), we found at respectively, 20 GW (20GW), 26GW, 30GW and 3 months in the postpartum (3MPP), 20%, 12,5%, 22%, and 18,7% patients with scores above the threshold defined by the scale
We find an association between a positive score to State-anxiety and Trait-anxiety for the Total group at 20GW (p = 0.037), but this association is not confirmed in the TTTS group
Summary
Monochorionic (MC) twin pregnancies represent 20–25% of all twin pregnancies with a continuously increasing incidence [1] [2] Their morbidity and mortality rates are higher than in dichorionic pregnancies, because of their specific complications that include selective intrauterine growth restriction (IUGR), intra-uterine fetal demise (IUFD) and twin-to-twin transfusion syndrome (TTTS). The latter, called twin oligoamnios polyhydramnios sequence, complicates around 15% of MC pregnancies. The immediate post-operative surveillance is based on repeated ultrasound examinations at 16, 24, 36 and 48 hours post-operatively followed by weekly follow-up ultrasonographies for the rest of the pregnancy This follow-up is pursued until 34 weeks when the patient will have a cesarean section [5] [6] [7]. This management leads to at least one twin survival rate around 88% to 92%, and a mean survival of both twins between 52% and 75% [8]
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