When to Deliver Monochorionic Diamniotic Twins in the Setting of Preeclampsia [21O

Abstract

INTRODUCTION: Monochorionic diamniotic (MCDA) twin pregnancies are at increased risk of preeclampsia (PET), intrauterine growth restriction (IUGR) and intrauterine fetal demise (IUFD). Our study compared outcomes of induction of labor (IOL) at 34 through 37 weeks to determine the most favorable gestational age for delivery in MCDA twin pregnancies complicated by mild PET. METHODS: A decision analytic model was created using TreeAgePro 2017 software to compare the outcomes of expectant management versus IOL at 34 to 37 weeks of gestational age. Outcomes examined included quality adjusted life years (QALYs), cases of advancement from mild to severe PET, maternal mortality, maternal stroke, IUGR, IUFD, cerebral palsy (CP) and neonatal mortality. Probabilities, utilities, and life expectancies were derived from the literature. Univariate analyses were used to investigate the impact of labor induction at various gestational ages. RESULTS: In a theoretical cohort of 10,000 MCDA pregnancies complicated by PET, IOL at 34 weeks resulted in the fewest cases of severe PET (0), maternal stroke (15), maternal mortality (4), IUFD (0), and IUGR (1,183). However, this strategy was also associated with the most cases of neonatal CP (91) and neonatal mortality (90). Neonatal CP and mortality were lowest in the 37 week IOL strategy group at 47 and 67, respectively. QALYs were highest (867,342) when IOL occurred at 36 weeks. CONCLUSION: MCDA twin pregnancies complicated by mild PET should be induced at 36 weeks. When compared to IOL at 37 weeks, this strategy reduces maternal and neonatal morbidity and mortality.