Document Detail


Contemporary management of monochorionic diamniotic twins: outcomes and delivery recommendations revisited.
MedLine Citation:
PMID:  20579959     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: We sought to investigate outcomes of contemporaneously managed monochorionic diamniotic (MCDA) twins, stratified by pregnancy complication. STUDY DESIGN: Four hundred eighteen MCDA pregnancies from 2001 through 2008 were retrospectively reviewed. RESULTS: There were 236 ongoing pregnancies at 24 weeks' gestation. The likelihood of progressing from 24 weeks to 2 live births was 98.7% in uncomplicated pregnancies, 89.7% with twin-twin transfusion syndrome, and 100% with growth discordance, increasing at 32 weeks to 99.5%, 93.8%, and 100%, respectively. The relative risk (RR) of birth <32 weeks was significantly greater in twin-twin transfusion syndrome (RR, 4.1; 95% confidence interval, 2.7-6.1) and growth discordant (RR, 2.1; 95% confidence interval, 1.8-3.8) pregnancies than in uncomplicated pregnancies (P < .0001). CONCLUSION: This represents one of the largest cohorts of MCDA twins. The risk of third-trimester fetal loss was low. The likelihood of both intrauterine fetal demise and preterm birth were greater in complicated pregnancies. In the absence of a clinical indication for delivery, these data do not support elective preterm delivery for prevention of intrauterine fetal demise in uncomplicated MCDA twins.
Authors:
Nicole A Smith; Louise Wilkins-Haug; Joaquin Santolaya-Forgas; David Acker; Katherine E Economy; Carol B Benson; Julian N Robinson
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Publication Detail:
Type:  Comparative Study; Journal Article; Twin Study     Date:  2010-06-26
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  203     ISSN:  1097-6868     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-27     Completed Date:  2010-08-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  133.e1-6     Citation Subset:  AIM; IM    
Copyright Information:
Copyright (c) 2010 Mosby, Inc. All rights reserved.
Affiliation:
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA 02115, USA. nasmith@partners.org
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MeSH Terms
Descriptor/Qualifier:
Adult
Cohort Studies
Delivery, Obstetric / methods*
Diseases in Twins / epidemiology,  therapy,  ultrasonography
Female
Fetofetal Transfusion / epidemiology,  therapy,  ultrasonography
Gestational Age
Humans
Incidence
Maternal Age
Maternal Mortality / trends
Obstetric Labor, Premature / epidemiology,  therapy
Parity
Perinatal Mortality / trends
Pregnancy
Pregnancy Complications / diagnosis,  epidemiology*,  therapy
Pregnancy Outcome / epidemiology*
Retrospective Studies
Risk Assessment
Stillbirth
Twins, Monozygotic*
Ultrasonography, Prenatal
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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