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Obstetrics
The outcome of monochorionic diamniotic twin gestations in the era of invasive fetal therapy: a prospective cohort study

Presented at the 17th World Congress on Ultrasound in Obstetrics and Gynecology, Florence, Italy, Oct. 7-11, 2007.
https://doi.org/10.1016/j.ajog.2008.03.050Get rights and content

Objective

The purpose of this study was to document pregnancy and neonatal outcome of monochorionic diamniotic twin pregnancies.

Study Design

This observational study describes a prospective series included in the first trimester in 2 centers of the Eurotwin2twin project.

Results

Of the 202 included twin pairs, 172 (85%) resulted in 2 survivors, 15 (7.5%) in 1 survivor, and 15 (7.5%) in no survivors. The mortality was 45 of 404 (11%), and 36 of 45 (80%) were fetal losses of 24 weeks or less, 5 of 45 (11%) between 24 weeks and birth, and 4 of 45 (9%) were neonatal deaths. Twin-to-twin transfusion syndrome (TTTS) occurred in 18 of 202 (9%). The mortality of TTTS was 20 of 36 (55%), which accounted for 20 of 45 (44%) of all losses. Severe discordant growth without TTTS occurred in 29 of 202 (14%). Its mortality was 5 of 58 (9%), which accounted for 5 of 45 (11%) of all losses. Major discordant congenital anomalies occurred in 12 of 202 (6%). Of the 178 pairs that continued after 24 weeks, 10 (6%) had severe hemoglobin differences at birth. After 32 weeks, the prospective risk of intrauterine demise was 2 in 161 pregnancies (1.2%; 95% confidence interval, 0.3-4.6).

Conclusion

Of the monochorionic twins recruited in the first trimester, 85% resulted in the survival of both twins, and 92.5% resulted in the survival of at least 1 twin. Most losses were at 24 weeks or less, and TTTS was the most important cause of death. After 32 weeks, the risk of intrauterine demise appears to be small.

Section snippets

Study protocol

Patients were recruited during a 5-year study period (January 2002-January 2007) between 11 and 14 weeks of gestation and following the diagnosis of a monochorionic diamniotic twin pregnancy by standard first-trimester ultrasound criteria.7 Patients with single or double demise or twin-reversed arterial perfusion sequence (TRAP) at the time of presentation were not included. Also, triplets containing a monochorionic twin pair, as well as monochorionic twin pregnancies resulting from the

Results

In the 5-year study period, 202 monochorionic diamniotic (MCDA) twin pairs were enrolled between 11 and 14 weeks' gestation. Two cases were not included, 1 case with the diagnosis of TRAP sequence and 1 with double IUFD, and sirenomelia in 1 twin at the time of referral. Outcome was available of all included twins, and no case was excluded from the analysis. The demographic data and details on pregnancy and neonatal outcome are summarized in Table 1. The mean GA at delivery was 35 ± 2 weeks,

Comment

We report the outcome of the largest prospective series of MCDA twins followed from the first trimester onward. Of the 202 twin pregnancies, 85% resulted in 2 survivors, 7.5% in a single survivor, and 7.5% in no surviving infant. These figures are comparable with what was reported by Sebire et al1 on 102 MCDA twins enrolled in the first trimester with double survival, single survival, and no survival in 82%, 6%, and 12%, respectively.1 However, the series by Sebire et al covered the period

Acknowledgment

We thank the many clinicians in Belgium and Germany that referred their monochorionic twin pregnancies for participation in the study. We also thank the European Commission for supporting this work in their fifth framework program.

References (23)

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    The hidden mortality of monochorionic twin pregnancies

    Br J Obstet Gynaecol

    (1997)

    • Cited by (0)

    Cite this article as: Lewi L, Jani J, Blickstein I, et al. The outcome of monochorionic diamniotic twin gestations in the era of invasive fetal therapy: a prospective cohort. Am J Obstet Gynecol 2008;199:514.e1-514.e8.

    Reprints not available from the authors.

    Drs L. Lewi, Jani, and Huber are the recipients of a grant of the Fifth Framework Program of the European Commission (#QLG1-CT-2002-01632 EuroTwin2Twin). Dr Doné is the recipient of a grant within the Marie Curie Program of the European Commission (MEST CT2005 019707).

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