Assessing an impact on perinatal outcome in monochorionic and dichorionic twin pregnancy complicated with discordant fetal growth

Introduction. Multifetal pregnancy is associated with an increased risk of perinatal morbidity and mortality. Type of placentation and discordant fetal growth may be risk factors of adverse pregnancy outcomes.Aim: to compare an impact of dichorionic and monochorionic twin pregnancies with symmetric and discordant fetal growth on perinatal outcomes, as well as morbidity and mortality.Materials and Methods. There was conducted a retrospective study of 485 pregnant women and paired 959 newborns. Depending on the type of chorionicity, subjects were stratified into two study groups being further subdivided into based on describing fetal weight discordance. The antenatal period and the neonatal outcome of newborns in groups and subgroups were compared.Results. We analyzed 308 dichorionic and 177 monochorionic twin pregnancies. It was found that neonate discordant growth was observed in 5.4 % and 13.4 % (p < 0.001), respectively. The incidence of assisted reproductive technologies was higher in dichorionic than in monochorionic twins comprising 66.5 and 40.7 % (р < 0.001). Antenatal mortality in monochorionic vs. dichorionic twins was by 8-fold higher. The preterm birth rate in monochorionic vs. dichorionic twins was 74.6 and 62.7% (p = 0.009), respectively. Neonate body weight in monochorionic vs. dichorionic twins was lowered comprising 1991 and 2430 gr. (р < 0.001), respectively. Low Apgar scores were more common for monochorionic twins with discordant body weight. The rate of early neonatal mortality in monochorionic vs. dichorionic twins was 4.4 % vs. 1.5 % (p = 0.009), whereas in dichorionic vs. monochorionic twins with weight discordance it was up to 5.8 and 10.5% (р < 0.001), respectively.Conclusion. Monochorionic twin pregnancy complicated with growth discordance is associated with a higher risk of adverse antenatal period as well as neonatal morbidity and mortality compared to symmetric DCDA twins. Chorionicity and growth discordancy represent important predictors for outcome of twin pregnancy.

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Relapse of Human Chorionic Gonadotropin-Induced Hyperthyroidism and Severe Hyperemesis Gravidarum Secondary to Twin-Twin Transfusion Syndrome, With Rapid Recovery Following Fetoscopic Laser Coagulation: Case Report

Frontiers in Endocrinology ◽

10.3389/fendo.2021.705567 ◽

2021 ◽

Vol 12 ◽

Author(s):

Faiza Lamine ◽

Chiara Camponovo ◽

David Baud ◽

Dominique Werner ◽

Laura Marino ◽

...

Keyword(s):

Chorionic Gonadotropin ◽

Human Chorionic Gonadotropin ◽

Twin Pregnancy ◽

Assisted Reproductive Technologies ◽

Hyperemesis Gravidarum ◽

Reproductive Technologies ◽

Laser Coagulation ◽

Monochorionic Twin ◽

Fetoscopic Laser Coagulation ◽

Twin Pregnancies

BackgroundLimited data have shown that, compared to uncomplicated twin pregnancies, pregnancies complicated by twin-twin transfusion syndrome (TTTS), a life-threatening condition, are associated with higher maternal serum levels of both human chorionic gonadotropin (hCG) and thyroid hormones. With the continuing expansion of assisted reproductive technologies, the rate of twin pregnancies, including those complicated by TTTS and associated hyperemesis gravidarum, is expected to increase further. Therefore, detailed descriptions of the maternal and fetal clinical outcomes of maternal thyrotoxicosis linked to TTTS can be useful for timely diagnosis and management. However, such descriptions are currently lacking in the literature.Case PresentationWe report the case of a 30-year-old woman carrying a monochorionic twin pregnancy complicated by TTTS that induced a relapse of severe hyperemesis gravidarum with overt non-autoimmune hyperthyroidism at 17 weeks of gestation. Following fetoscopic laser coagulation (FLC), both hyperemesis and hyperthyroidism improved within 1 week.ConclusionsThe present experience contributes to the knowledge base on maternal thyrotoxicosis linked to TTTS and can be useful in the diagnosis and treatment of future cases; it also emphasizes the need for a high degree of clinical suspicion and for close collaboration between endocrinologists and obstetricians. Another key point is that TTTS-associated hyperemesis gravidarum and maternal hyperthyroidism should be considered in the differential diagnosis of refractory or relapsing hyperemesis gravidarum in women with monochorionic twin pregnancy, because this condition may require more stringent supportive treatment before and during the FLC procedure when the mother is overtly hyperthyroid.

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Monozygotic twinning associated with assisted reproductive technologies: a review

Reproduction ◽

10.1530/rep-08-0206 ◽

2008 ◽

Vol 136 (4) ◽

pp. 377-386 ◽

Cited By ~ 131

Author(s):

K I Aston ◽

C M Peterson ◽

D T Carrell

Keyword(s):

Assisted Reproductive Technologies ◽

Monozygotic Twin ◽

Developed Countries ◽

Reproductive Technologies ◽

Monochorionic Twins ◽

Fertility Treatments ◽

Increased Risk ◽

Mz Twins ◽

Twin Pregnancies ◽

Natural Incidence

Twin birth rates have increased markedly in developed countries since the 1970s for two primary reasons: increasing maternal age and the advent and increasing use of fertility treatments. In addition, monozygotic (MZ) twin pregnancies have been reported to occur at a significantly higher rate following assisted reproductive technologies (ART) procedures compared with the natural incidence. Twin pregnancies are of concern due to a dramatically increased risk of associated complications. Monozygotic twin pregnancies carry a 10–20% risk of twin–twin transfusion syndrome, and monoamniotic monochorionic twins are additionally at risk for cord entanglement. While the mechanisms and contributory factors for dizygotic twinning are well established, very little is known about the mechanisms involved in MZ twinning or the factors that contribute to its occurrence. In this review, we will discuss a number of potential mechanisms involved in MZ twinning and explore factors that may be contributing to the increased incidence of ART-associated MZ twins. An improved understanding of the factors that contribute to increased MZ twinning associated with ART will help to elucidate the poorly understood mechanisms involved in the process and will further aid in reducing the overall incidence of multiple pregnancies with their associated risks following ART procedures.

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Effects of twin pregnancy chorionic properties on fetal outcomes: a comparative study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20203860 ◽

2020 ◽

Vol 9 (9) ◽

pp. 3802

Author(s):

Gigi A. ◽

Rachel Alexander ◽

Radhamani K.

Keyword(s):

Twin Pregnancy ◽

Prospective Observational Study ◽

Perinatal Outcomes ◽

Fetal Outcomes ◽

Monochorionic Twins ◽

Monochorionic Twin ◽

Medical College ◽

Placental Membranes ◽

The Mean ◽

Twin Pregnancies

Background: Twins carry significant risks to both mothers and babies. The purpose of this study was to evaluate chorionicity and its impact on perinatal outcomes in twins.Methods: This prospective observational study was conducted in the department of obstetrics and gynecology, Government T. D. Medical College, Alappuzha, Kerala. A total of 106 cases of twin pregnancies were included in the prospective descriptive study. Based on the ultrasound results and methods of the postpartum pathologic examination of the placental membranes, the cases were divided into the twin group with monochorionic diamniotic (MCDA) and twin group with dichorionic diamniotic (DCDA group). The relationships of different chorionic properties and fetal outcomes were determined by comparing various fetal outcomes.Results: Among 106 twin pregnancies, 61.3% were DCDA twins, 38.7% were MCDA. Average maternal age of monochorionic twin was 25 and that of dichorionic twin was 27. Perinatal mortality of monochorionic twin was 14.7% when compared to 8.6% for dichorionic twin. The mean gestational age for monochorionic twin pregnancy was 34.78 weeks whereas it was 35.91 weeks for dichorionic pregnancy. Elective and emergency LSCS was done more for dichorionic twin pregnancies compared to monochorionic twin pregnancies. Low Apgar scores were seen in monochorionic twins compared to dichorionic twins.Conclusions: The incidence of fetal outcomes in the monochorionic group was inferior to those in the dichorionic group. The fetal outcomes may be improved by determining the chorionic properties in early pregnancy by using ultrasound and consequently planning for pregnancy monitoring and intervention.

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Ultrasonographic diagnosis of twins in two pregnant bitches: case report

Arquivo Brasileiro de Medicina Veterinária e Zootecnia ◽

10.1590/1678-4162-11331 ◽

2020 ◽

Vol 72 (1) ◽

pp. 102-106

Author(s):

L. Pavan ◽

B. Gasser ◽

V.J.C. Santos ◽

M.C. Maronezi ◽

P. Silva ◽

...

Keyword(s):

Twin Pregnancy ◽

Fetal Death ◽

The Other ◽

Multiple Pregnancies ◽

Monochorionic Twins ◽

Monochorionic Twin ◽

Ultrasonographic Diagnosis ◽

Placental Site ◽

Twin Pregnancies ◽

Two Bodies

ABSTRACT Multiple pregnancies in humans account for only 3% of pregnancies, 97-98% of which are twin pregnancies and the morbimortality is higher in the monochorionic twins when compared to dichorionic ones. The canine species is naturally multiparous, but the diagnosis of monochorionic twin pregnancy is not common. The objective of this report was to describe the ultrasonographic diagnosis of monochorionic twin pregnancies in two bitches [Pug (case 1) and Shih tzu (case 2)]. It was possible to verify the presence of one gestational vesicle containing two fetuses in each female by observing two heads or two bodies within the same placental site. These fetuses presented adequate viability and normal organogenesis. Their development was similar to the other fetuses. In case 1 they were stillborn and smaller than the other five live-born fetuses. The twins in case 2 were born alive, but they also appeared smaller when compared to the littermates. The gestational risks associated with this condition in pregnant bitches are still unknown, however, there are reports of fetal death in monochorionic pregnancies in this species. Therefore, ultrasonographic exam during pregnancy allows an early monochorionic diagnosis and monitoring the fetal viability could bring health benefits to both the female and the littermates.

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Twin pregnancies

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/a-1344-4812 ◽

2021 ◽

Author(s):

Nicole Ochsenbein-Kölble

Keyword(s):

Amniotic Fluid ◽

Fetal Growth ◽

First Trimester ◽

Cervical Length ◽

Monochorionic Twins ◽

Diastolic Velocity ◽

Increased Risk ◽

Specialized Care ◽

Fetal Malformations ◽

Twin Pregnancies

AbstractTwin pregnancies, resulting in 2–3 % of all deliveries, are high risk pregnancies which need specialized care. A correct dating of pregnancy and the assessment of the chorionicity/amnionicity in the first trimester (< = 13 + 6 gestational weeks, GW) is essential for further monitoring. During first trimester risk stratification of monochorionic pregnancies includes evaluation of discordance of crown-rump-lengths, nuchal translucencies and amniotic fluid. At 16 GW sonographic risk evaluation of monochorionic twins involves differences in amniotic fluid and abdominal circumferences and detection of a velamentous cord insertion. A screening for fetal malformations with cervical length measurement as screening for preterm birth (cut-off < 25 mm) should be offered all twin pregnancies around 20 GW. In uncomplicated dichorionic pregnancies US examination should be performed every 4 weeks onwards to check fetal growth and amniotic fluid. An intertwin weight discordance > 20 % identifies pregnancies at increased risk of adverse outcome. Monochorionic pregnancies should be followed at least every two weeks for screening of twin-twin transfusion syndrome (TTTS), twin-anemia-polycythemia-sequence (TAPS) and selective fetal growth retardation (sFGR) with a start at 16 GW. The type 1–3 classification of sFGR in monochorionic twins depends on the pattern of end-diastolic velocity at the umbilical artery Doppler. The diagnosis of TTTS requires the presence of an oligyohydramnios (deepest vertical pocket (DVP) < 2 cm) in the donor twin and a polyhydramnios (DVP > 8 cm) in the recipient twin. However, the diagnosis of TAPS is based on the finding of discordant MCA Doppler values with a delta-MCA PV > 0.5 MoM.

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Invasive Procedures in Monochorionic Twins

Donald School Journal of Ultrasound in Obstetrics & Gynecology ◽

10.5005/jp-journals-10009-1415 ◽

2015 ◽

Vol 9 (3) ◽

pp. 280-292

Author(s):

Aris Antsaklis ◽

Panagiotis Antsaklis

Keyword(s):

Chromosomal Abnormalities ◽

Clinical Skills ◽

Invasive Procedures ◽

Monochorionic Twins ◽

Monochorionic Twin ◽

Arterial Perfusion ◽

Trap Sequence ◽

Increased Risk ◽

Twin Pregnancies ◽

Twin Reversed Arterial Perfusion

ABSTRACT Monochorionic twin pregnancies (MC) are less frequent but they are considered higher risk pregnancies compared to dichorionic pregnancies. As a result, determining the chorionicity of a twin pregnancy is of vital importance for the surveillance and management of the pregnancy. The problem originates from the fact that monochorionic twins have one placenta, and as a result the circulation of the two fetuses is closely related to each other mainly through anastomosis of the placenta. The number and type of anastomosis is of great importance for the course of the pregnancy. Diagnosis of chromosomal abnormalities in such pregnancies requires excellent knowledge of invasive procedures and good clinical skills. Monochorionic twins are at increased risk for unique complications including twin-to-twin transfusion syndrome (TTTS), selective intrauterine growth restriction (sIUGR), and twin-reversed arterial perfusion (TRAP) sequence. Twin-to-twin transfusion syndrome is a very well known and described complication of monochorionic twin pregnancies and must be considered and checked in each monochorionic pregnancy. Selective feticide is not a method used very commonly in MC pregnancies, but may be applied in selected cases. For TTTS laser treatment of the anastomosis is a method of choice, but should be performed in centers with experience. How to cite this article Antsaklis A, Antsaklis P. Invasive Procedures in Monochorionic Twins. Donald School J Ultrasound Obstet Gynecol 2015;9(3):280-292.

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Growth patterns of monochorionic twin pregnancies complicated by type‐3 selective fetal growth restriction

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.23752 ◽

2021 ◽

Author(s):

S. Shinar ◽

W. Xing ◽

L. Lewi ◽

F. Slaghekke ◽

Y. Yinon ◽

...

Keyword(s):

Fetal Growth ◽

Fetal Growth Restriction ◽

Growth Patterns ◽

Growth Restriction ◽

Monochorionic Twin ◽

Type 3 ◽

Twin Pregnancies

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Yearly Changes in Stillbirth Rates of Zygotic Twins in Japan, 1975-1994

Acta geneticae medicae et gemellologiae twin research ◽

10.1017/s0001566000000349 ◽

1998 ◽

Vol 47 (1) ◽

pp. 19-30 ◽

Cited By ~ 5

Author(s):

Y. Imaizumi ◽

K. Nonaka

Keyword(s):

Medical Care ◽

Twin Pregnancy ◽

Japanese Women ◽

Stillbirth Rate ◽

Monochorionic Twin ◽

Mz Twins ◽

Twin Pregnancies

AbstractThe stillbirth rates decreased to 2/3 for MZ male twins, 1/2 for MZ female twins, and under 1/2 for DZ twins for both sexes during the 19-year period from 1975 in Japan. The stillbirth rate was significantly higher in MZ males than MZ females in each year, whereas stillbirth rates of DZ twins for both sexes indicated similar values during that period. After 1986, stillbirth rates were more than 2 times higher in MZ twins than in singletons and in DZ twins. The higher stillbirth rate of MZ twins as opposed to DZ twins could be related to monochorionic twin pairs in MZ twins. The stillbirth rate decreased more drastically in twins for both zygosities than in singleton births during the 34-year period from 1960. However, declining rates of stillbirths may be attributed to medical care during twin pregnancies. Recommendation of an optimum day to give birth for twin pregnancy is 37-38 weeks for Japanese women.

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Editorial–Special Issue

Twin Research and Human Genetics ◽

10.1017/thg.2016.30 ◽

2016 ◽

Vol 19 (3) ◽

pp. 167-167 ◽

Cited By ~ 2

Author(s):

Mark P. Umstad ◽

Ricardo Palma-Dias ◽

Asma Khalil

Keyword(s):

Well Being ◽

Morbidity And Mortality ◽

Perinatal Morbidity ◽

Special Issue ◽

Monochorionic Twin ◽

Editorial Special Issue ◽

Twin Pregnancies

Monochorionic twin pregnancies are subject to unique complications that can threaten the life and well-being of both fetuses, resulting in a disproportionate increase in perinatal morbidity and mortality.

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