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Pregnancy Outcome of Monochorionic Twins: Does Amnionicity Matter?

Published online by Cambridge University Press:  21 February 2012

Thiran Dias ,
Elena Contro ,
Basky Thilaganathan ,
Hina Khan ,
Cristina Zanardini ,
Samina Mahsud-Dornan  and
Amar Bhide
Thiran Dias
Affiliation:
Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's University of London, United Kingdom
Elena Contro
Affiliation:
Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's University of London, United Kingdom
Basky Thilaganathan
Affiliation:
Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's University of London, United Kingdom
Hina Khan
Affiliation:
Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's University of London, United Kingdom
Cristina Zanardini
Affiliation:
Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's University of London, United Kingdom
Samina Mahsud-Dornan
Affiliation:
Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's University of London, United Kingdom
Amar Bhide*
Affiliation:
Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's University of London, United Kingdom
*
ADDRESS FOR CORRESPONDENCE: Dr Amar Bhide, Fetal Medicine Unit, St George's Hospital, Blackshaw Road, SW17 9QT London UK. E-mail: abhide@sgul.ac.uk

Abstract

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Objective: To compare the fetal loss rate of monochorionic (MC) twin pregnancies according to their amnionicity. Methods: A retrospective review of all MC pregnancy outcomes in a tertiary centre. Pregnancy outcomes were compared for monochorionic monoamniotic (MCMA) versus monochorionic diamniotic (MCDA) pregnancies. Results: 29 MCMA and 117 MCDA twin pregnancies were identified. The overall fetal loss rate was significantly higher in MCMA (23/52, 44.2%) compared to MCDA pregnancies (28/233, 12%, Chi squared = 30.03, p < .001). Kaplan-Meier analysis showed that fetal survival rate in MCDA twins were significantly higher than in MCMA twins (Log-rank Chi-squared = 27.9, p < .0005). Early pregnancy ultrasound identified the causes for these fetal losses in some MCMA twins. After exclusion of identifiable causes, the difference in fetal survival was not significant in the two groups (Log-rank chi-squared = 0.373, p = .54). Conclusion: The loss rate for MCMA twins is high and occurs mainly due to discordant congenital abnormality, conjoint twins or twin reversed arterial perfusion (TRAP) sequence. Although the fetal loss rate in MCDA is lower than in MCMA pregnancies, the majority of fetal loss in MCDA pregnancies cannot be predicted at the first scan at presentation. The data of this study questions the widespread policy of a difference in the scheduling of elective delivery for MCMA and MCDA twins.

Type
Articles
Information
Twin Research and Human Genetics , Volume 14 , Issue 6 , December 2011 , pp. 586 - 592
Copyright
Copyright © Cambridge University Press 2011

References

Acosta-Rojas, R., Becker, J., Munoz-Abellana, B., Ruiz, C., Carreras, E., & Gratacos, E. (2007). Twin chorionicity and the risk of adverse perinatal outcome. International Journal of Gynaecology and Obstetrics, 96, 98–102.CrossRefGoogle ScholarPubMed
Aisenbrey, G. A., Catanzarite, V. A., Hurley, T. J., Spiegel, J. H., Schrimmer, D. B., & Mendoza, A. (1995). Monoamniotic and pseudomonoamniotic twins: sonographic diagnosis, detection of cord entanglement, and obstetric management. Obstetrics and Gynecology, 86, 218–222.CrossRefGoogle ScholarPubMed
Allen, V. M., Windrim, R., Barrett, J., & Ohlsson, A. (2001). Management of monoamniotic twin pregnancies: a case series and systematic review of the literature. British Journal of Obstetrics and Gynaecology, 108, 931–936.CrossRefGoogle ScholarPubMed
Baxi, L., & Walsh, C. (2010). Monoamniotic twins in contemporary practice: A single-center study of perinatal outcomes. The Journal of Maternal-Fetal and Neonatal Medicine, 23, 506–510.CrossRefGoogle Scholar
Chitrit, Y., Filidori, M., Pons, J. C., Duyme, M., & Papiernik, E. (1999). Perinatal mortality in twin pregnancies: A 3-year analysis in Seine Saint-Denis (France). European Journal of Obstetrics and Gynecology, 86, 23–28.CrossRefGoogle ScholarPubMed
Colburn, D. W., & Pasquale, S. A. (1982). Monoamniotic twin pregnancy. Journal of Reproductive Medicine, 27, 165–168.Google ScholarPubMed
D'Alton, M. E., & Simpson, L. L. (1995). Syndromes in twins. Seminars in Perinatology, 19, 375–386.CrossRefGoogle ScholarPubMed
Demaria, F., Goffinet, F., Kayem, G., Tsatsaris, V., Hessabi, M., & Cabrol, D. (2004). Monoamniotic twin pregnancies, antenatal management and perinatal results of 19 consecutive cases. BJOG, 111, 22–26.CrossRefGoogle ScholarPubMed
Denbow, M. L., Cox, P., Taylor, M., Hammal, D. M., & Fisk, N. M. (2000). Placental angioarchitecture in monochorionic twin pregnancies: relationship to fetal growth, fetofetal transfusion syndrome and pregnancy outcome. American Journal of Obstetrics and Gynecology, 182, 417–426.CrossRefGoogle ScholarPubMed
Derom, C., Vlietinck, R., Derom, R., Van den Berghe, H., & Thiery, M. (1988). Population-based study on sex proportion in monoamniotic twins. New England Journal of Medicine, 319, 119–120.Google Scholar
Dias, T., Bhide, A., & Thilaganathan, B. (2010). Early pregnancy growth and pregnancy outcome in twin pregnancies. Ceylon Medical Journal, 55, 80–84.CrossRefGoogle ScholarPubMed
Dias, T., Mahsud-Dornan, S., Bhide, A., Papageorghiou, A., & Thilaganathan, B. (2010). Cord entanglement and perinatal outcome in monoamniotic twin pregnancies. Ultrasound Obstetrics and Gynecology, 35, 201–204.CrossRefGoogle ScholarPubMed
Ezra, Y., Shveiky, D., Ophir, E., Nadjari, M., Eisenberg, V. H., Samueloff, A., & Rojansky, N. (2005). Intensive management and early delivery reduce antenatal mortality in monoamniotic twin pregnancies. Acta Obstetrics and Gynecology Scandinavica, 84, 432–435.CrossRefGoogle ScholarPubMed
Fick, A. L., Feldstein, V. A., Norton, M. E., Wassel Fyr, C., Caughey, A. B., & Machin, G. A. (2006). Unequal placental sharing and birth weight discordance in monochorionic diamniotic twins. American Journal of Obstetrics and Gynecology, 195, 178–183.CrossRefGoogle ScholarPubMed
Gratacós, E., Antolin, E., Lewi, L., Martínez, J. M., Hernandez-Andrade, E., Acosta-Rojas, R., Enríquez, G., Cabero, L., & Deprest, J. (2008). Monochorionic twins with selective intrauterine growth restriction and intermittent absent or reversed end-diastolic flow (Type III): Feasibility and perinatal outcome of fetoscopic placental laser coagulation. Ultrasound Obstetrics and Gynecology, 31, 669–675.CrossRefGoogle ScholarPubMed
Hack, K. E., Derks, J. B., Elias, S. G., Franx, A., Roos, E. J., Voerman, S. K., Bode, C. L., Koopman-Esseboom, C., & Visser, G. H. (2008). Increased perinatal mortality and morbidity in monochorionic versus dichorionic twin pregnancies, clinical implications of a large Dutch cohort study. BJOG, 115, 58–67.CrossRefGoogle ScholarPubMed
Hack, K. E., Van Gemert, M., Lopriore, E., Schaap, A., Eggink, A., Elias, S., Van den Wijngaard, J., Vandenbussche, F., Derks, J., Visser, G., & Nikkels, P. (2009). Placental characteristics of monoamniotic twin pregnancies in relation to perinatal outcome. Placenta, 30, 62–65.CrossRefGoogle ScholarPubMed
Hack, K. E., Derks, J. B., Schaap, A. H., Lopriore, E., Elias, S. G., Arabin, B., Eggink, A. J., Sollie, K. M., Mol, B. W., Duvekot, H. J., Willekes, C., Go, A. T., Koopman-Esseboom, C., Vandenbussche, F. P., & Visser, G. H. (2009). Perinatal outcome of monoamniotic twin pregnancies. Obstetrics and Gynecology, 113, 353–360.CrossRefGoogle ScholarPubMed
Hamilton, S., & Byrd, L. (2009). Cord entanglement and/or knotting: Is this only a feature of monochorionic monoamniotic pregnancies? Journal of Obstetrics and Gynaecology, 29, 244–245.CrossRefGoogle ScholarPubMed
Heyborne, K. D., Porreco, R. P., Garite, T. J., Phair, K., & Abril, D. (2005). Obstetrix/Pediatrix Research Study Group. Improved perinatal survival of monoamniotic twins with intensive inpatient monitoring. American Journal of Obstetrics and Gynecology, 192, 96–101.CrossRefGoogle Scholar
Lewi, L., Jani, J., Blickstein, I., Blickstein, I., Huber, A., Gucciardo, L., Van Mieghem, T., Don'e, E., Boes, A., Hecher, K., Gratacos, E., Lewi, P., & Deprest, J. (2008). The outcome of monochorionic diamniotic twin gestations in the era of invasive fetal therapy, a prospective cohort study. American Journal of Obstetrics and Gynecology, 199, 514.e1–8.CrossRefGoogle ScholarPubMed
Pasquini, L., Wimalasundera, R. C., Fichera, A., Barigye, O., Chappell, L., & Fisk, N. M. (2006). High perinatal survival in monoamniotic twins managed by prophylactic sulindac, intensive ultrasound surveillance, and Cesarean delivery at 32 weeks' gestation. Ultrasound in Obstetrics and Gynecology, 28, 681–687.CrossRefGoogle ScholarPubMed
Powers, W. F., & Kiely, J. L. (1994). The risks confronting twins: A national perspective. American Journal of Obstetrics and Gynecology, 170, 456–461.CrossRefGoogle ScholarPubMed
Quintero, R., Morales, W., Allen, M., Bornick, P., Johnson, P., & Krueger, M. (1999). Staging of twin-twin transfusion syndrome. Journal of Perinatology, 19, 550–555.CrossRefGoogle ScholarPubMed
Raphael, S. I. (1961). Monoamniotic twin pregnancy: A review of the literature and a report of 5 new cases. American Journal of Obstetrics and Gynecology, 81, 323–330.CrossRefGoogle Scholar
Roqué, H., Gillen-Goldstein, J., Funai, E., Young, B., & Lockwood, C. (2003). Perinatal outcome in monoamniotic gestations. Journal of Maternal Fetal and Neonatal Medicine, 13, 414–421.CrossRefGoogle ScholarPubMed
Rodis, J. F., Mcllveen, P. F., Egan, J. F., Borgida, A. F., Turner, G. W., & Campbell, W. A. (1997). Monoamniotic twins, improved perinatal survival with accurate prenatal diagnosis and antenatal fetal surveillance. American Journal of Obstetrics and Gynecology, 177, 1046–1049.CrossRefGoogle ScholarPubMed
Senat, M. V., Deprest, J., Boulvain, M., Paupe, A., Winer, N., & Ville, Y. (2004). Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. New England Journal of Medicine, 351, 136–144.CrossRefGoogle ScholarPubMed
Simonsen, M. (1966). Monoamniotic twins. Acta Obstetrics and Gynecology Scandinavica, 45, 43–52.CrossRefGoogle ScholarPubMed
Smith, N. A., Wilkins-Haug, L., Santolaya-Forgas, J., Acker, D., Economy, K. E., Benson, C. B., & Robinson, J. N. (2010). Contemporary management of monochorionic diamniotic twins: Outcomes and delivery recommendations revisited. American Journal of Obstetrics and Gynecology, 203, 133.e1–6.CrossRefGoogle ScholarPubMed
Timmons, J. D., & Dealvarez, R. R. (1963). Monoamniotic twins pregnancy. American Journal of Obstetrics and Gynecology, 86, 875–881.CrossRefGoogle Scholar
Umur, A., van Gemert, M. J., & Nikkels, P. G. (2003). Monoamniotic-versus diamniotic-monochorionic twin placentas, anastomoses and twin-twin transfusion syndrome. American Journal of Obstetrics and Gynecology, 189, 1325–1329.CrossRefGoogle ScholarPubMed