Monochorionic Diamnionic Twins Research Articles

Abnormal umbilical cord insertion and birth weight discordancy in monochorionic diamniotic twins: A retrospective study

To investigate the relationship between abnormal umbilical cord insertion and birthweight discordance in monochorionic diamnionic (MCDA) twins. A total of 137 pairs of MCDAs were retrospectively analyzed who delivered and survived in Hangzhou Women's Hospital from January 2016 to December 2021. According to different insertion methods, they were divided into normal cord insertion group (n = 57), marginal cord insertion (MCI) group (n = 34) and velamentous cord insertion (VCI) group (n = 46). The correlation was analyzed between different insertion methods of umbilical cord and the discordant birth weight of MCDAs. The gestational age of delivery with velamentous cord insertion was significantly earlier than those with normal and marginal insertion (P < .05). There were significant differences in birthweight between large fetus (F1) and small fetus (F2) with different umbilical insertion methods (P < .05). The birthweight of F1 and F2 in normal insertion group was significantly higher than those in MCI and VCI group (P < .05). Logistic regression analysis showed that VCI was significantly associated with birth weight in F1/F2, birthweight discordance ≥ 20%, and birthweight discordance ≥ 25%, however MCI and VCI were not an independent factor for discordance in birthweight of MCDAs (P > .05). Umbilical cord insertion method can lead to inconsistency in birthweight of MCDA twins, however they were not an independent factor for discordance in birthweight.

Analysis of clinical characteristics of discordant structural malformations in one of monochorionic diamnionic twins

Objective: To analyze the clinical characteristics of structural malformations in one of monochorionic diamnionic twins (MCDA). Methods: The clinical data of 77 MCDA patients with structural malformations diagnosed by ultrasound were retrospectively reviewed from January 2012 to May 2017. The distribution of structural malformations, prenatal chromosomal karyotyping and pregnancy outcomes were analyzed. Results: (1)Among the 77 MCDA patients with structural malformations, the single malformation accounted for 79%(61/77), the multiple malformations accounted for 21%(16/77). And there were a total of 94 types of malformations, the top three malformations were neurological malformations (32%, 30/94), cardiovascular malformations (29%, 27/94) and twin reversed arterial perfusion sequence (TRAPS;10%,9/94).(2)Among the 77 patients with structural malformation, 64 cases (83%, 64/77) were examined for fetal chromosomes, of whom 14 cases (22%,14/64) were examined for fetal chromosomes of both twins, with 1 case (1/14) of discordant fetal chromosome. (3)Among the 77 patients, 4 cases (5%, 4/77) with severe fetal malformations terminated pregnancy. Totally 29 cases (38%,29/77) with severe malformations were treated with selective fetal reduction, among whom 7 cases (24%, 7/29) experienced unexplained fetal death within 24 hours after the operation; 2 cases (7%, 2/29) happened inevitable abortion, and 2 cases (7%, 2/29) underwent unexplained fetal death during the late pregnancy. Of the remaining 44 patients (57%,44/77) with expectant treatment, 13 cases (30%,13/44) occurred twin transfusion syndrome (Ⅱ-Ⅳ), and were treated with fetoscopic laser occlusion. Eight patients had 2 survival twins, 4 patients delivered 1 survival twin, and 1 patient had dead twins. Conclusions: The most common malformations in MCDA twins are the nervous malformations, cardiovascular malformations and TRAPS. The chromosome karyotype of MCDA twins with structural malformations are sometimes discordant, and separate samling of the twins is suggested for prenatal diagnosis. Selective fetal reduction could be given to severe structural malformation in MCDA patients safely and effectively. For non-severe structural malformation in MCDA patients with twin transfusion syndrome, fetoscopic laser occlusion is safe and effective.

Assessment of fetal cardiovascular function after radio-frequency ablation in complicated monochorionic diamnionic twins

Objective To evaluate retained fetal cardiovascular function after radio frequency ablation in complicated monochorionic diamnionic twins. Methods A total of 19 complicated monochorionic diamnionic twins [10 twin-twin transfusion syndrome (TTTS) and 9 selective intrauterine growth restricted (sIUGR)] who were diagnosed at Fetal Medicine Center of the First Affiliated Hospital of Sun Yat-Sen University from December 2013 to July 2015 were enrolled, and the cardiovascular profile score (CVPS) and Tei index of retained fetus were measured preoperatively and postoperatively at 24 h, 3 days, 1 week, 1 month, 2 months respectively.Each case was matched by normal fetuses with same gestational age as control group and the same parameters were measured. Results (1) TTTS: CVPS [(8.71±1.11) scores] was increased significantly at 3 days postoperatively compared with preoperation [(6.86±2.12) scores], and there was a statistical significance(t=2.571, P 0.05) as compared with controls [(10.00±0.00) scores]. Tei indexes of the left ventricle (LV-Tei) (0.41±0.06) and Tei indexes of the right ventricle (RV-Tei)(0.42±0.06) decreased as compared with those before operation (LV-Tei: 0.66±0.19, RV-Tei: 0.63±0.12) with sig-nificant difference (LV: t=-3.193, P 0.05) as compared with the controls (LV-Tei: 0.35±0.03, RV-Tei: 0.35±0.03). (2)sIUGR: CVPS [(9.71±0.45) scores ]showed no statistical significance 1 week after operation (P>0.05) as compared with controls[(10.00±0.00) scores]. Tei indexes of the right and left ventricle 1 week after operation were lower than after operation with significant difference(LV-Tei: 0.39±0.04 vs.0.47±0.06, t=-6.687, P 0.05), LV-Tei(0.36±0.02) showed no statistical significance 1 month after operation(P>0.05). Conclusions Retained fetal cardiovascular function of TTTS and sIUGR can be restored obviously after operation.In TTTS, its cardiovascular function is recovered completely 1 month postope-ratively.In sIUGR, its cardiovascular function is recovered completely 1 week postoperatively. Key words: Monochorionic diamnionic twins; Radio frequency; Ablation; Cardiac function; Echocardiogram

A case of sex-discordant monochorionic diamnionic twins due to spontaneous pregnancy

A case of sex-discordant monochorionic diamnionic twins due to spontaneous pregnancy

Delivery of Monochorionic Twins in the Absence of Complications

Objective We sought to estimate the optimal time to deliver uncomplicated monochorionic-diamnionic (MCDA) twins. Study Design Data were retrospectively obtained from twin pregnancies from 2000 through 2009. The gestational week–specific prospective perinatal mortality risk was calculated. A cohort of MCDA twins with nonindicated deliveries was analyzed separately. Neonatal outcomes and costs were compared between MCDA twins with nonindicated deliveries born at specific weeks of gestation, and those born the subsequent week. Results There were 5894 dichorionic-diamnionic twins and 1704 MCDA twins. After 28 weeks, the gestational week–specific prospective risk of perinatal mortality did not differ between groups. There were 948 MCDA twins with nonindicated deliveries. Until 37 weeks, the risk of severe neonatal morbidity, perinatal mortality, and hospital costs were greater for fetuses delivered compared to fetuses born in a subsequent week. Conclusion To optimize neonatal outcome and decrease hospital costs, MCDA twins should not be delivered

Delivery of monochorionic twins in the absence of complications: analysis of neonatal outcomes and costs

We sought to estimate the optimal time to deliver uncomplicated monochorionic-diamnionic (MCDA) twins. Data were retrospectively obtained from twin pregnancies from 2000 through 2009. The gestational week-specific prospective perinatal mortality risk was calculated. A cohort of MCDA twins with nonindicated deliveries was analyzed separately. Neonatal outcomes and costs were compared between MCDA twins with nonindicated deliveries born at specific weeks of gestation, and those born the subsequent week. There were 5894 dichorionic-diamnionic twins and 1704 MCDA twins. After 28 weeks, the gestational week-specific prospective risk of perinatal mortality did not differ between groups. There were 948 MCDA twins with nonindicated deliveries. Until 37 weeks, the risk of severe neonatal morbidity, perinatal mortality, and hospital costs were greater for fetuses delivered compared to fetuses born in a subsequent week. To optimize neonatal outcome and decrease hospital costs, MCDA twins should not be delivered <37 weeks unless medically indicated.

The concern of ART treatment on maternal transport cases in the tertiary perinatal center

OBJECTIVE: The purpose of this study was to evaluate the concern of ART treatment in the tertiary perinatal center.DESIGN: Retrospective study.MATERIALS AND METHODS: From January 2003 to December 2007, there were 1790 deliveries in our tertiary perinatal center. There were 958 referred cases including 48 ART treatments (24 conventional IVF-ET, 1 ICSI, 13 cryopreserved embryo transfer, 10 cryopreserved blastocysto transfer). In these cases, factors for referral and obstetrical outcomes (multiple pregnancies, pregnancy outcomes, congenital anomalies, growth restriction) were studied.RESULTS: Common factors on referral cases were 201 threatened premature labor including 11 ART cases, 69 maternal complications including 2 ART cases, 62 multiple pregnancies including 14 ART cases, 57 IUGR (intrauterine growth restriction) and PIH (pregnancy induced hypertention) including 8 ART cases, and 31 congenital anomalies including 3 ART cases. In referral cases, there were 193 emergency maternal transports including 7 ART treatments. The most common factor for emergency transport was threatened premature labor (123 cases including 7 ART). About referral multiple pregnancies, there were 4 triplet pregnancies including 1 ART, 38 DD (dichorionic, diamnionic) twin pregnancies including 9 ART, 18 MD (monochorionic, diamnionic) twin pregnancies including 4 ART, and 2 MM (monochorionic, monoamnionic) twin pregnancies. Those multiple pregnancies were 14 cases after ART (assisted reproduction technology), 15 after OI (ovulation induction), and 33 natural conceived. There were 7 TTTS (twin-to-twin transfusion syndrome) pregnancies including 3 ART cases. The number of spontaneous abortions and still births was 59 including 10 after ART. In cryopreserved blastocysto transfer cases, IUFD (intrauterine fetal death) and congenital anomalies were more frequent than other ART treatments.CONCLUSIONS: In emergency maternal transport, there was no concern of ART treatment. However, the increased risk of multiple pregnancies, TTTS, IUFD, and congenital anomalies was noted in ART treatment cases. OBJECTIVE: The purpose of this study was to evaluate the concern of ART treatment in the tertiary perinatal center. DESIGN: Retrospective study. MATERIALS AND METHODS: From January 2003 to December 2007, there were 1790 deliveries in our tertiary perinatal center. There were 958 referred cases including 48 ART treatments (24 conventional IVF-ET, 1 ICSI, 13 cryopreserved embryo transfer, 10 cryopreserved blastocysto transfer). In these cases, factors for referral and obstetrical outcomes (multiple pregnancies, pregnancy outcomes, congenital anomalies, growth restriction) were studied. RESULTS: Common factors on referral cases were 201 threatened premature labor including 11 ART cases, 69 maternal complications including 2 ART cases, 62 multiple pregnancies including 14 ART cases, 57 IUGR (intrauterine growth restriction) and PIH (pregnancy induced hypertention) including 8 ART cases, and 31 congenital anomalies including 3 ART cases. In referral cases, there were 193 emergency maternal transports including 7 ART treatments. The most common factor for emergency transport was threatened premature labor (123 cases including 7 ART). About referral multiple pregnancies, there were 4 triplet pregnancies including 1 ART, 38 DD (dichorionic, diamnionic) twin pregnancies including 9 ART, 18 MD (monochorionic, diamnionic) twin pregnancies including 4 ART, and 2 MM (monochorionic, monoamnionic) twin pregnancies. Those multiple pregnancies were 14 cases after ART (assisted reproduction technology), 15 after OI (ovulation induction), and 33 natural conceived. There were 7 TTTS (twin-to-twin transfusion syndrome) pregnancies including 3 ART cases. The number of spontaneous abortions and still births was 59 including 10 after ART. In cryopreserved blastocysto transfer cases, IUFD (intrauterine fetal death) and congenital anomalies were more frequent than other ART treatments. CONCLUSIONS: In emergency maternal transport, there was no concern of ART treatment. However, the increased risk of multiple pregnancies, TTTS, IUFD, and congenital anomalies was noted in ART treatment cases.