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Pregnancy outcome of monochorionic twins: does amnionicity matter?
MedLine Citation:
PMID:  22506316     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
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.
Authors:
Thiran Dias; Elena Contro; Basky Thilaganathan; Hina Khan; Cristina Zanardini; Samina Mahsud-Dornan; Amar Bhide
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Twin research and human genetics : the official journal of the International Society for Twin Studies     Volume:  14     ISSN:  1832-4274     ISO Abbreviation:  Twin Res Hum Genet     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2012-04-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101244624     Medline TA:  Twin Res Hum Genet     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  586-92     Citation Subset:  IM    
Affiliation:
Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's University of London, United Kingdom.
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