DCDA Twin Pregnancy Research Articles

Maternal and Perinatal Outcomes in Twins conceived Spontaneously Versus by Art –A Prospective Observational Study

Background: Multifetal pregnancies are on the rise due to advanced treatment modalities for infertility and assisted reproductive techniques (ART). These pregnancies are associated with more maternal and fetal morbidities as compared to singleton gestations. Even among twin pregnancies, those conceived by ART have been shown to be associated with adverse outcomes as compared to their spontaneously conceived counterparts. Objectives: The primary objective was to examine whether DCDA twin pregnancies conceived after ART were at a higher risk of adverse outcomes as compared to their spontaneously conceived counterparts. The secondary objective was to assess the maternal and fetal complications in the twin pregnancies.

529 Association between method of conception of DCDA twin pregnancies and hypertensive disorders of pregnancy

529 Association between method of conception of DCDA twin pregnancies and hypertensive disorders of pregnancy

Delivery timing in dichorionic diamniotic twin pregnancies complicated by preeclampsia: a decision analysis

Objective To determine the optimal timing of delivery in Dichorionic-diamniotic (DCDA) pregnancies complicated by preeclampsia without severe features. Methods A decision-analytic model was created to compare outcomes of expectant management vs. delivery from 34 to 37w0d. Outcomes included quality-adjusted life years (QALYs), development of severe preeclampsia, maternal mortality, maternal stroke, small for gestational age (SGA) due to fetal growth restriction (FGR) detected antenatally, stillbirth, cerebral palsy (CP), and neonatal mortality. Probabilities, utilities, and life expectancies were derived from the literature. Univariate analysis was used to evaluate the impact of delivery at various gestational ages. Maternal and neonatal outcomes were calculated for a theoretical cohort of 10,000 DCDA pregnancies with preeclampsia. Results The optimal gestational age for delivery was 36w0d when the total QALYs (868,112) were highest. Delivery at 34w0d resulted in the fewest cases of severe preeclampsia, maternal mortality, and maternal stroke (0, 4, and 15 cases per 10,000, respectively). The incidence of each of these adverse outcomes increased with gestational age, with the greatest number of adverse outcomes at 37w0d (2452 cases of severe preeclampsia, eight maternal deaths, and 31 cases of maternal stroke per 10,000). Delivery at 34w0d resulted in the fewest cases of severe preeclampsia (0), maternal stroke (15), maternal mortality (4), stillbirth (0), and SGA (1183). However, this strategy was also associated with most cases of neonatal CP (91) and neonatal mortality (87). Conclusion DCDA twin pregnancies complicated by preeclampsia without severe features appear to have the best outcomes when delivered at 36w0d. Specifically, when compared to delivery at 37w0d, this strategy reduced maternal and neonatal morbidity and mortality.

Obstetric and Perinatal Outcomes of Dichorionic-Diamniotic Twin Pregnancies Conceived by IVF/ICSI Compared with Those Conceived Spontaneously.

This study aimed to investigate differences in mater-nal and perinatal outcomes between dichorionic-diamniotic (DCDA) twin pregnancies between those conceived spontaneously and those conceived through in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). This study was a single-center, retrospective cohort study. All women with DCDA twin pregnancies were considered for inclusion. Monochorionic twins and higher-order multiple pre-gnancies were excluded. All data related to maternal and perinatal outcomes were extracted from the hospital database and compared between spontaneously conceived DCDA twin pregnancies and those conceived by IVF/ICSI. Multivariable logistic regression was used to adjust for confounders to determine factors associated with maternal and perinatal outcomes. Of 739 identified DCDA twin pregnancies, 483 (65.4%) were conceived through IVF/ICSI treatment (IVF/ICSI group), and 256 (34.6%) were spontaneously conceived (SC group). Women in the IVF/ICSI group were older and had fewer previous live births than women in the SC group. The women in the IVF/ICSI group had significantly higher risks of preeclampsia (adjusted odds ratio [aOR]: 2.50; 95% confidence interval [CI]: 1.12-5.55), cesarean delivery (aOR: 2.0; 95% CI: 1.27-3.17), an postpartum hemorrhage following cesarean section (aOR: 3.15; 95% CI: 1.53-6.45). The DCDA twins in the IVF/ICSI group were delivered at an earlier gestational age (36.2 vs. 36.7 weeks, p < 0.001), had slightly lower mean birth weights (2298 vs. 2367 g, p = 0.005), and required more respiratory support (aOR: 0.69; 95% Cl: 0.48-0.98) than those in the SC group. Our study demonstrated that women with DCDA twin pregnancies conceived through IVF/ICSI experienced more complications than those with SC DCDA twin pregnancies. Newborns in the IVF/ICSI group had a slightly lower mean birth weight and required respiratory support more frequently, but no other significant differences in perinatal outcomes or perinatal mortality were observed between the two groups.

Mode of birth in monochorionic versus dichorionic twin pregnancies: a retrospective study from a large tertiary centre in Germany

BackgroundOptimal mode of birth for twins, in particular monochorionic twins, has been the subject of much debate. This retrospective study compared maternal and newborn outcomes after vaginal birth in monochorionic and dichorionic twins, utilizing a large institutional database.MethodsRetrospective analysis focusing on 98 monochorionic-diamniotic (MC-DA) and 540 dichorionic-diamniotic (DC-DA) twin births extracted from the perinatal database of a large German hospital. Pregnancies ≥36 weeks of gestation with two viable foetuses born between 2004 and 2014 divided into planned vaginal and planned caesarean delivery were included. Descriptive analysis was performed for maternal characteristics. Odds ratios (OR) with 95% confidences intervals (CI) tested the predictive effect of vaginal birth on neonatal and maternal outcomes.Results51.0% MC-DA and 46.7% DC-DA twin pregnancies were planned vaginal births and 44.0% MC-DA mothers and 43.7% DC-DA mothers actually gave birth vaginally. The overall rate of caesarean section (CS) during the years under observation was 79.6% for MC-DA and 77.0% for DC-DA pregnancies. There were no significant differences in neonatal outcome between the subsamples, although acidosis was observed more often in the second DC-DA twin and Apgar scores < 7 were observed more often in MC-DA twins.ConclusionVaginal birth may be recommended as an option to women with monochorionic twins as no significant differences in outcomes were found between MC-DA and DC-DA twins. However, over half of planned vaginal twin births resulted in CS.

OP02.05: Clinical application of cervical shear wave elastography in predicting the risk of preterm delivery in DCDA twin pregnancy

OP02.05: Clinical application of cervical shear wave elastography in predicting the risk of preterm delivery in DCDA twin pregnancy

Association between IVF/ICSI treatment and preterm birth and major perinatal outcomes among dichorionic-diamnionic twin pregnancies: A seven-year retrospective cohort study.

This study aimed to evaluate the preterm birth and additional perinatal outcomes between spontaneous and in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) dichorionic-diamnionic (DCDA) twin pregnancies. This retrospective cohort study was conducted in a tertiary university-affiliated medical center. All women with DCDA twin pregnancies were considered for inclusion. The primary outcome of interest was preterm birth <37weeks of gestation and secondary outcomes included spontaneous preterm birth, iatrogenic (induced) preterm birth, gestational diabetes mellitus, pregnancy-induced hypertensive disorder, preeclampsia, preterm premature rupture of membranes (PPROM), intrahepatic cholestasis of pregnancy, placenta previa, neonatal intensive care unit (NICU) admission, birthweight discordance, small for gestational age, neonatal respiratory distress syndrome, ventilator support, and perinatal death and/or severe morbidity. These outcomes were compared between IVF/ICSI and spontaneous twin pregnancies. Multivariable logistic regressions were used to adjust for confounders. General estimated equation models were used to address intertwin correlation. A total of 1297 twin pregnancies, including 213 spontaneous and 1084 IVF/ICSI DCDA pregnancies, met the inclusion criteria. Women with IVF/ICSI pregnancies were older and had higher body mass index, adherence with prenatal care and proportion of nulliparity. After adjustment for confounders, IVF/ICSI pregnancies were associated with a slight increase in preterm birth <37weeks of gestation (adjusted odds ratio [aOR] 1.72; 95% CI 1.24-2.39), iatrogenic preterm birth <37weeks of gestation (aOR 1.41; 95% CI 1.00-1.97) as well as NICU admission (aOR 1.34; 95% CI 1.00-1.80). IVF/ICSI pregnancies were associated with a decrease in PPROM (aOR 0.64; 95% CI 0.42-0.99). There were no differences between IVF/ICSI and spontaneous DCDA pregnancies in terms of spontaneous preterm birth, gestational diabetes mellitus, pregnancy-induced hypertensive disorder, preeclampsia, intrahepatic cholestasis of pregnancy, placenta previa, birthweight discordance, small for gestational age, neonatal respiratory distress syndrome, ventilator support, and perinatal death and/or severe morbidity. IVF/ICSI DCDA twin pregnancies were associated with a slight increase in preterm birth <37weeks of gestation, iatrogenic preterm birth <37weeks of gestation, and NICU admission but with a decrease in PPROM. Other outcomes were comparable between IVF/ICSI and spontaneous DCDA twin pregnancies. Multicenter studies with adequate power remain warranted.

Outcomes of ultrasound-indicated cerclage in twin pregnancies with a short cervical length

ObjectiveTo investigate the outcomes of ultrasound-indicated cerclage in dichorionic-diamniotic (DCDA) twin pregnancies with a short cervical length. Materials and methodsThis was a retrospective cohort study of DCDA twin pregnancies with a short cervical length (≤25 mm) from January 2000 to July 2017 to compare maternal and neonatal outcomes. Additional sub-analysis was performed by dividing the patients into two subgroups by a cervical length ≤15 mm and between 16 and 25 mm. ResultsOne hundred and eight women were initially diagnosed with twin pregnancies and cervical insufficiency. After excluding cases not meeting the study criteria, 46 women were recruited for analysis, of whom 33 underwent ultrasound-indicated cerclage. The delivery age of the cerclage group was significantly later than the non-cerclage group (34.85 ± 3.91 versus 31.08 ± 5.25 weeks, p = 0.011), and the latency was significantly longer in the cerclage group than in the non-cerclage group (86.09 ± 41.32 versus 52.31 ± 33.24 days, p = 0.014). Sub-analysis revealed that these benefits were significant in the subgroup of a cervical length ≤15 mm. Both first twin (twin A) and second twin (twin B) had a significantly decreased rate of neonatal intensive care unit admission in the cerclage group. However, twin A had more promising outcomes with significantly decreased rates of neonatal respiratory distress syndrome (6.7% versus 50.0%, p = 0.004) and sepsis (0% versus 25.0%, p = 0.019). ConclusionUltrasound-indicated cerclage in DCDA twin pregnancies can decrease preterm birth and prolong the latency. It also decreases neonatal morbidity, and is especially beneficial for twin A.

The Incidence of Dichorionic Diamniotic Twin Pregnancy After Single Blastocyst Embryo Transfer and Zygosity: 8 Years of Single-Center Experience.

Dichorionic diamniotic (DCDA) twin pregnancies after single blastocyst embryo transfer have been reported recently, although a blastocyst ovum is generally believed to divide into monochorionic twin pregnancy. We investigated the incidence of DCDA twin pregnancy after single blastocyst embryo transfer and their zygosity. This prospective cohort study included 655 consecutive twin pregnancies that were managed from 2006 to 2014 at our institution. Chorionicity and amnionicity were determined using first-trimester ultrasonography and/or placental pathology. Zygosity was analyzed if the cases were DCDA twins after single blastocyst embryo transfer. Among 655 twin pregnancies, there were 348 DCDA cases, 295 monochorionic diamniotic (MCDA) cases and 12 monochorionic monoamniotic cases. Single blastocyst embryo transfer was performed in 43 cases. Six out of the 43 (14%) cases involved DCDA twin pregnancies and the other 37 cases involved MCDA twin pregnancies. Three DCDA twins born after single blastocyst embryo transfer, wherein frozen embryo transfer (FET) was performed in the natural cycle, were dizygotic, and the other three cases, wherein FET with hormone replacement therapy was performed, were monozygotic. DCDA twin pregnancy occurred in 14% (7% for monozygotic and 7% for dizygotic) of twin pregnancies after single blastocyst embryo transfer cases.

DCDA twin pregnancy after endometrial ablation: Case presentation

DCDA twin pregnancy after endometrial ablation: Case presentation

Optimum time interval for intertwin delivery for extreme prematurity in DCDA twin pregnancy. A case report and a literature review

Due to increased use of ART delayed twin interval delivery has become a common occurrence. Multiple pregnancy is associated with high incidence of premature labour. Prematurity is the leading cause of neonatal morbidity and mortality all over the world as premature babies are at a greater risk of dying and has other health issues. Delivery of the presenting fetus usually followed by delivery of the second fetus shortly thereafter. There is no study available for the management of multifetal pregnancy, where one twin had delivered very prematurely and the time interval of the delivery for subsequent fetus. Conservation of pregnancy has good outcome when properly managed with careful surveillance. Survival rate increases by approximately 10% every week conserved in utero. Reservation persist in anticipation of increased maternal morbidity and mortality due to infection after conservative management.Time interval remains a dilemma in extreme prematurity.

Estimated energy requirements increase across pregnancy in healthy women with dichorionic twins

Estimated energy requirement (EER) has not been defined for twin pregnancy. This study was designed to determine the EER of healthy women with dichorionic-diamniotic (DCDA) twin pregnancies. We aimed to estimate energy deposition from changes in maternal body protein and fat; to measure resting energy expenditure (REE), physical activity level (PAL), and total energy expenditure (TEE) throughout pregnancy and postpartum; and to define the EER based on the sum of TEE and energy deposition for twin gestation. This is a prospective study of 20 women with DCDA twin gestations. Maternal EER, energy deposition, REE, TEE, and PAL were obtained during the first, second, and third trimesters of pregnancy and immediately postpartum. A mixed-effects linear regression model for repeated measures with random intercept was used to test for the effects of BMI groups and time. Gains in total body protein (mean±SD: 2.1±0.7 kg) and fat mass (5.9±2.8 kg) resulted in total energy deposition of 67,042±25,586 kcal between 0 and 30-32 weeks of gestation. REE increased 26% from 1392±162 to 1752±172 kcal/d across the 3 trimesters, whereas TEE increased 17% from 2141±283 to 2515±337 kcal/d. Physical activity decreased steadily throughout pregnancy. Reductions in physical activity did not compensate for the rise in REE and energy deposition, thus requiring an increase in dietary energy intake as pregnancy progressed. EER increased 29% from 2257±325 kcal/d in the first trimester to 2941±407 kcal/d in the second trimester, and stayed consistent at 2906±350 kcal/d in the third trimester. Increased energy intake, on average ∼700 kcal/d in the second and third trimesters when compared with the first trimester, is required to support gestational weight gain and the rise in energy expenditure of DCDA twin pregnancies.

Placental Histopathology Differences and Neonatal Outcome in Dichorionic-Diamniotic as Compared to Monochorionic-Diamniotic Twin Pregnancies.

We aimed to compare the differences in placental histopathology lesions and pregnancy outcome in dichorionic-diamniotic (DCDA) versus uncomplicated monochorionic-diamniotic (MCDA) twin gestations. Maternal characteristics, neonatal outcome, and placental histopathology reports of all twin deliveries between 24 and 41 weeks were reviewed. Excluded were pregnancies complicated by twin-to-twin transfusion syndrome, twin anemia-polycythemia sequence, selective intrauterine growth restriction, placenta previa, intrauterine fetal death, and malformation. Placental lesions were classified to maternal/fetal vascular malperfusion lesions. Umbilical cord abnormalities included hypo-/hypercoiling and abnormal insertion. Composite adverse neonatal outcome was defined as 1 or more early complications. Small for gestational age (SGA) was defined as birth weight ≤10th percentile. The DCDA group (n = 362) was characterized by higher rates of assisted reproductive techniques ( P < .001) and nulliparity ( P = .03) as compared to the MCDA group (n = 65). Gestational age at delivery was similar between groups. Placental maternal vascular malperfusion lesions were more common in placentas from DCDA group (38.2% vs 23.1%; P = .016), while fetal vascular malperfusion lesions and abnormal cord insertion were more common in placentas from MCDA group ( P = .027; P< .001). The SGA and composite adverse neonatal outcome were more common in the MCDA group ( P = .031 and P = .038, respectively). By multivariate regression analysis, composite adverse neonatal outcome was found to be independently associated with the MCDA group, adjusted odds ratio (aOR) = 1.2, 95% confidence interval (CI) = 1.04 to 1.89, P = .041, and with placental fetal malperfusion lesions aOR = 1.3, 95% CI = 1.1 to 2.09, P = .038. Placental pathology differs between MCDA and DCDA twin pregnancies. Adverse neonatal outcome in uncomplicated MCDA twins, as compared to DCDA twins, could be related to increased placental fetal malperfusion lesions and abnormal cord insertion.

PPO.52 Cervical Suture – A Single Centre Experience of Comparative Efficacy Between Elective, Semi-Elective and Rescue Sutures

IntroductionPreterm delivery is the leading cause for infant mortality and morbidity. Cervical incompetence is a recognised cause for both extreme prematurity and second trimester loss. Use of cervical sutures may...

PFM.55 Antenatal diagnosis of placental chorangioma: implications for clinical management

IntroductionChorangiomas (placental haemangiomas) are rarely diagnosed antenatally but have been associated with cardiac failure and poor outcome. The aim of this study was to review cases of antenatally diagnosed placental...

PM.99 Syphilis Serology in Pregnant Women Over a Period of 7 Years (2005–2011) in a Large Maternity Hospital in Dublin, Ireland

Nearly 1.5 million pregnant women are infected with probable active syphilis each year, and approximately half of infected pregnant women who are untreated, will experience adverse outcomes due to syphilis,...

PP.94 Delayed Interval Delivery in Multiple Pregnancy: A Case Report

We present a very unusual case of a set of twins delivering 87 days apart and with a birth weight difference of 1990 g with survival of both.A 33 year...

P14.02: Impact of first trimester discordance in crown to rump length in dichorionic diamniotic pregnancies on neonatal outcomes

Objectives: To determine the impact of first trimester crown to rump length (CRL) discordance in first trimester dichorionic diamniotic twins (DCDA) on neonatal outcomes. Methods: This is a prospective observational study of cohort of DCDA twin pregnancy over a period of eighteen months at a tertiary referral centre. During this period, 168 DCDA twin pregnancies were confirmed to have a viable twin pregnancy at 10–14 weeks scan for dating by crown rump length (CRL) and determine chorionicity. Outcome of pregnancies with CRL discordance of more than 10% were reviewed for variables including gestational age at delivery, mode of delivery, stillbirths, neonatal deaths and neonatal admissions. Results: Twenty two (13%) pregnancies had CRL discordance of >10%. The mean gestational age at delivery was 36 +6 (±,1.98) weeks’ gestation. Fourteen (63%) had delivery by caesarean section. Seven babies (16%) of the 22 pairs were admitted to the neonatal unit after birth. In six of the pairs (22%) the CRL discrepancy was >20% and in this group there were two stillbirths. One fetus died at 32 weeks gestation and other had Inencephaly and died at 34 weeks gestation. Further four babies (33%) were admitted to the neonatal unit immediately after birth. Conclusions: In DCDA twin pregnancies, CRL discordance of more than 20% is associated with increased risk of stillbirth and admission to neonatal unit.

Renal dialysis, diabetes and iugr: delivery and peripartum care

A woman with Type I diabetes presented at 6+0/40 with a history of severe retinopathy, hypertension and nephropathy. A previous combined renal and pancreatic transplant had failed necessitating haemodialysis five...