Outcome In Dichorionic Twins Research Articles

Role of fetal cardiac assessment in predicting adverse perinatal outcomes in preterm dichorionic twins

Aim: To investigate the role of the fetal modified myocardial performance index (Mod-MPI) and fetal cardiac output index measurement in predicting adverse perinatal outcomes among preterm dichorionic twins. Materials and Method: This prospective cohort study was conducted at the X Clinic and included 34 dichorionic twin fetuses born early preterm and 40 dichorionic twin fetuses born late preterm. The early preterm group was divided into two according to whether they were admitted to the neonatal intensive care unit (NICU). The groups' cardiac function and Mod-MPI measurements were compared regarding their predictive ability for adverse perinatal outcomes. Results: The Mod-MPI values were similar between the early and late preterm groups (p=0.144). The left ventricular cardiac output Z-score was lower in the preterm group (p=0.014). The Mod-MPI and left ventricular outflow tract-isovolumetric contraction and isovolumetric relaxation times were significantly higher among the newborns admitted to the NICU in the early preterm group (p=0.002, p=0.003, and p=0.001, respectively). Conclusion: Our study suggests that the Mod-MPI measurement can be used to predict adverse perinatal outcomes in dichorionic twin fetuses born in the early preterm period.

Is Increasing Parity Associated with Adverse Perinatal Outcomes in Dichorionic Twin Gestations?

Dichorionic twins have increased risk of preterm birth and hypertensive disorders of pregnancy. Grand multiparity may be associated with adverse perinatal outcomes in singleton pregnancies, although the effect of increasing parity in twins is unclear. This study aimed to elucidate whether grand multiparity leads to adverse outcomes in dichorionic twins compared with multiparity and nulliparity. This was a retrospective review of dichorionic twins at a single institution between January 2008 and December 2019 comparing pregnancy outcomes among grand multiparity, multiparity, and nulliparity. Primary outcome was preterm birth less than 37 weeks. Multivariable regression controlled for differing demographics, prior preterm birth, use of reproductive technologies, and hypertensive disorders of pregnancy. Chi square and Fisher's exact were used for categorical variables and Kruskal-Wallis was used for continuous variables. A total of 843 (60.3%) pregnancies were nulliparous, 499 (35.7%) multiparous, and 57(4.1%) grand multiparous. Univariate analysis indicated that multiparous women had lower incidence of preterm birth less than 37, 34, and 32 weeks (57 vs. 51%, p = 0.04; 19.2 vs. 14.0%, p = 0.02; 9.6 vs. 5.6%, p = 0.01) and that grand multiparous women had lower incidence of preterm birth less than 34 weeks (19.2 vs. 5.3%, p = 0.008) compared with nulliparous women. Multivariable regression confirmed multiparous women had lower odds of preterm birth less than 34 and 32 weeks compared with nulliparous women (<34 wk: odds ratio [OR] = 0.69, 95% confidence interval [CI] = 0.49-0.97, p = 0.03; <32 wk: OR = 0.48, 95% CI = 0.29-0.79, p = 0.004) and that multiparous women (OR = 0.57, 95% CI = 0.42-0.77, p = 0.0002) and grand multiparous women (OR = 0.23, 95% CI = 0.08-0.68, p = 0.0074) had lower incidence of hypertensive disorders of pregnancy when compared with nulliparous women. Grand multiparity is not associated with adverse perinatal outcomes compared with nulliparity or multiparity in dichorionic twins. Increasing parity may protect against incidence of preterm birth and hypertensive disorders of pregnancy even among grand multiparous women. · Incidence of preterm birth may decrease with increasing parity in twins.. · Hypertensive disorders of pregnancy may decrease with increasing parity in twins.. · Grand multiparity is not associated with adverse perinatal outcomes in twins..

Selective Fetal Growth Restriction in Dichorionic Twin Pregnancies: Diagnosis, Natural History, and Perinatal Outcome.

This study aims to evaluate the natural history, disease progression, and outcomes in dichorionic twins with selective fetal growth restriction (sFGR) according to different diagnostic criteria and time of onset. Dichorionic twins seen from the first trimester were included. sFGR was classified according to the Delphi consensus, and was compared to the outcomes of those classified by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) diagnostic criteria. Early sFGR occurred before 32-weeks, and late sFGR after 32-weeks. Disease progression, neonatal outcomes such as gestation at delivery, birthweight, neonatal unit (NNU) admission, and morbidities were compared. One-hundred twenty-three of 1053 dichorionic twins had sFGR, where 8.4% were classified as early sFGR, and 3.3% were late sFGR. Disease progression was seen in 36%, with a longer progression time (5 vs. 1 week) and higher progression rate (40% vs. 26%) in early sFGR. Perinatal death was significantly higher in the sFGR than the non-sFGR group (24 vs. 16 per 1000 births, p = 0.018), and those with early sFGR had more NNU admissions than late sFGR (p = 0.005). The ISUOG diagnostic criteria yielded a higher number of sFGR than the Delphi criteria, but similar outcomes. sFGR have worse perinatal outcomes, with early onset being more prevalent. Use of the Delphi diagnostic criteria can reduce over-diagnosis of sFGR and avoid unnecessary intervention.

EP21.13: Perinatal outcome of dichorionic twins reduced to singletons versus dichorionic twins managed expectantly

EP21.13: Perinatal outcome of dichorionic twins reduced to singletons versus dichorionic twins managed expectantly

930: To push or not to push: delivery management and newborn outcomes in dichorionic twins

930: To push or not to push: delivery management and newborn outcomes in dichorionic twins

2.2 Abnormal cerebroplacental ratio predicts adverse outcomes in dichorionic twins

ObjectiveTo evaluate the significance of an abnormal cerebroplacental ratio (CPR) in twin pregnancies.Study designIn the prospective multicenter ESPRiT study, twin pregnancies underwent serial sonographic evaluation including multi-vessel Doppler studies. CPR...

An analysis of pregnancy outcome in dichorionic and monochorionic twins given special antenatal and intranatal care: a four-year survey.

The present study aims to analyze perinatal outcomes in twins given special care during pregnancy and labor and to compare fetal and neonatal outcomes in dichorionic twins with monochorionic twins. Eighty eight (88) twin pregnancies booked for care at a tertiary care Fetal Medicine centre were included in this study. The maternal demographic variables, course of pregnancy, fetal problems, and specialized fetal therapeutic and diagnostic interventions were noted. The above parameters were compared in the sub-groups of dichorionic and monochorionic twin pregnancies and related to the perinatal outcome. Statistical analysis was done using the student's t test and the two-tailed chi sqaure tests with Yate's continuity correction. A p value <0.05 was considered as significant. Mean maternal age was 30.34+4.81years (range 19-48). 81% of the twins were DCDA, and 19% were MCDA. The mean gestational age at delivery was 34.4±3.5weeks, and this was not significantly different in MCDA and DCDA groups. Serious fetal problems warranting intervention at the time of initial referral were significantly higher in MCDA twins although overall perinatal outcome in both groups were not different. Specialized care during pregnancy and labor including active fetal surveillance and therapeutic intervention when indicated improves the perinatal outcome in twin pregnancies and ensured at least one healthy live birth in over 90% cases, although with an increase in late prematurity.

First-trimester growth discordance and adverse pregnancy outcome in dichorionic twins

To evaluate the association between first-trimester growth discordance and adverse pregnancy outcome in dichorionic twin pregnancies. This was a retrospective cohort study of consecutive women with dichorionic twin pregnancies undergoing an ultrasound scan at our institution between 7 and 14 weeks' gestation. Study groups were defined by the presence or absence of ≥ 11% crown-rump length (CRL) discordance. Pregnancies were excluded if one twin was dead on initial ultrasound or if a termination was performed. The primary outcome was loss of one or both fetuses before 20 weeks. Secondary outcomes included fetal anomaly, fetal demise after 20 weeks (stillbirth), small-for-gestational-age (SGA) at birth, admission to the neonatal intensive care unit (NICU) and preterm delivery before 34 weeks. Of 805 dichorionic twin pregnancies undergoing first-trimester ultrasound, 610 met the inclusion criteria. Eighty-six had ≥ 11% CRL discordance and, of these, nine (10.5%) had a fetal loss at < 20 weeks (risk ratio (RR) 7.8 (95% CI, 3.0-20.5)). In the surviving pregnancies, an increased risk of fetal anomalies was seen (27.3 vs 17.4%, RR 1.6 (95% CI, 1.1-2.4)). In surviving pregnancies unaffected by anomalies, no increased risk of stillbirth, SGA, NICU admission or delivery before 34 weeks was noted in the discordant group. A post-hoc power analysis demonstrated 80% power to detect a five-fold increase in the risk of stillbirth and 90% power to detect a two-fold increase in other outcomes. Dichorionic pregnancies in which a CRL discordance of at least 11% is noted are at increased risk for fetal anomalies and fetal loss prior to 20 weeks' gestation. However, patients can be reassured that, in the absence of structural anomalies, CRL discordance does not appear to be associated with other adverse outcomes in continuing pregnancies, although the power to detect small increases in the risk of stillbirth may have been limited by the sample size.

359: Crown-rump length discordance and adverse pregnancy outcomes in dichorionic twins

Growth discordance in twin pregnancy is considered a risk factor for adverse perinatal outcomes. However, data is conflicting regarding the significance of first trimester growth discordance. Our objective was to determine the association of first trimester growth discordance and adverse pregnancy outcomes in dichorionic twin pregnancies.

OC124: Discordance of first trimester crown‐rump‐length (CRL) measurements is a predictor of adverse outcome in dichorionic twins

OC124: Discordance of first trimester crown‐rump‐length (CRL) measurements is a predictor of adverse outcome in dichorionic twins

Obstetric outcomes in nulliparous women aged 35 and over with dichorionic twin pregnancy

The aim of this study is to investigate maternal and neonatal outcomes in dichorionic twins to nulliparous women older than 35 compared to those of their younger counterparts. This was a retrospective study of dichorionic twin pregnancies managed at Japanese Red Cross Katsushika Maternity Hospital between 2002 and 2006. Nulliparous women 35 years and older at delivery (n = 60) were compared with nulliparous women between the ages of 20 and 29 at delivery (n = 71). The women > or = 35 year old were more likely to have used assisted reproductive technology. There were no measurable differences in obstetric outcomes such as preeclampsia, premature delivery, low birth weight and neonatal asphyxia between the two pregnancies. Advanced maternal age does not seem to affect obstetric outcomes in nulliparous dichorionic twin pregnancies.

Persistance of adverse obstetric and neonatal outcomes in monochorionic twins after exclusion of disorders unique to monochorionic placentation

This study was undertaken to assess obstetric and neonatal outcomes in dichorionic twins and monochorionic-diamniotic twins after exclusion of twin-to-twin transfusion syndrome and twin reversed arterial perfusion sequence. Data from a tertiary center were collected in twin gestations between 1994 and 2002. Chorionicity was defined by standard echographic criteria and placental examination at delivery. Neonatal outcomes were compared between monochorionic and dichorionic gestations. This study included 503 women: 378 (75%) dichorionic and 125 (25%) monochorionic twin gestations. Monochorionic twin gestations had a higher risk of preterm deliveries between 30 and 34 weeks' gestation than pregnancies with dichorionic twins (P < .01). Monochorionic twins had a higher number of birth weight less than 10th percentile (P < .001) discordancy 25% or greater (P < .02), admission to neonatal intensive care unit (P < .03), and intraventricular hemorrhage grade 3 and 4 (P < .007) than dichorionic twins even after adjusting for gestational age. Monochorionic diamniotic twins have a higher risk of perinatal complications than dichorionic twin gestations, even after exclusion of disorders unique to monochorionic placentation.