Document Detail


Early fetal loss in monochorionic and dichorionic twin pregnancies: the STORK multiple pregnancy cohort.
MedLine Citation:
PMID:  23208731     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Objectives: Monochorionic (MC) twins are at increased risk of early fetal loss secondary to vascular complications such as twin-twin transfusion syndrome (TTTS). The aim of this study is to compare the early perinatal loss rates between MC and dichorionic (DC) twins in an era of invasive treatment for TTTS. Methods: This was a retrospective study of all twin pregnancies of known chorionicity from a large regional cohort of 9 hospitals over a ten year period. Ultrasound data were matched to hospital delivery records and a mandatory national register of pregnancy losses. Prospective risk of pregnancy loss from 14 to 24 weeks' gestation was calculated and the survival trend of MC and DC twins was analysed using Kaplan-Meier survival analysis. Results: The analysis included 3117 twin pregnancies (605 MC and 2512 DC). The total risk of early pregnancy loss (miscarriage and neonatal death) before 24 weeks in MC twins (60.3 per 1000 fetuses) was significantly higher than in DC twins (6.5 per 1000 fetuses), with a hazard ratio (HR) of 9.18 (95% CI, 6.0-13.9). Survival analysis showed a significant difference in overall and early mortality between MC and DC twins (Log-rank test, p<0.0001), while no difference was noted after 24 weeks of gestation (Log-rank test, p=0.08). Conclusions: Early pregnancy loss is significantly more common in MC than in DC twins, but the trend in prospective risk of mortality in MC twins is not evident after 24 weeks' gestation. This rate has almost halved compared to those in the published literature. Early detection and prompt treatment of complications in MC twins is likely to have contributed to this improvement in outcomes. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
Authors:
Francesco D'Antonio; Asma Khalil; Thiran Dias; Basky Thilaganathan;
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-3
Journal Detail:
Title:  Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology     Volume:  -     ISSN:  1469-0705     ISO Abbreviation:  Ultrasound Obstet Gynecol     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-4     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9108340     Medline TA:  Ultrasound Obstet Gynecol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
Affiliation:
Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK.
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