Startseite Expectant management in di-chorionic pregnancies complicated by discordant anomalous twin
Artikel
Lizenziert
Nicht lizenziert Erfordert eine Authentifizierung

Expectant management in di-chorionic pregnancies complicated by discordant anomalous twin

  • Paola Algeri EMAIL logo , Francesca M. Russo , Maddalena Incerti , Sabrina Cozzolino , Francesca Pelizzoni , Davido P. Bernasconi , Luca Montanelli , Luca Locatelli und Patrizia Vergani
Veröffentlicht/Copyright: 12. Juli 2017

Abstract

Fetal malformations are more frequent in twins than in singletons. The aim of our study was to define the influence of a malformed twin on di-chorionic pregnancy outcomes. We performed a retrospective cohort study of di-chorionic pregnancies delivered between 2000 and 2015. Exclusion criteria were: both twins affected by fetal malformations, double intra-uterine fetal death in pregnancies without fetal malformation, selective feticide and therapeutic pregnancy termination. We compared maternal and fetal outcomes of di-chorionic pregnancies not complicated by fetal malformations with pregnancies affected by a single malformed fetus with conservative management. We included 642 di-chorionic pregnancies: 56 (case group, 8.7%) with one twin affected by a malformation (20 minor, 36 major ones), 586 (control group, 91.3%) without fetal malformation. No differences were found on maternal and not malformed co-twin outcomes when compared to pregnancies with no malformation; case vs control group presented similar rates of preeclampsia (8.9% vs. 10.8%, respectively), intrauterine growth restriction (7.1% vs. 9.4%) and composite adverse neonatal outcomes (19.6% vs. 15.1%). No case of fetal death in not malformed co-twin was reported. Expectant management could be a safe option for both mother and co-twin in case of di-chorionic twin pregnancy complicated by only one malformed fetus.


Corresponding author: Paola Algeri, MD, Department of Obstetrics and Gynecology, University of Milano-Bicocca, MBBM Foundation, S. Gerardo Hospital, Via Pergolesi 33, Monza 20900, Monza e Brianza, Italy, Phone: +392333113, Fax: +392333131

  1. Author’s statement

  2. Conflict of interest: Authors state no conflict of interest.

  3. Material and methods: Informed consent: Informed consent has been obtained from all individuals included in this study.

  4. Ethical approval: The research related to human subject use has complied with all the relevant national regulations, and institutional policies, and is in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional review board or equivalent committee.

References

[1] Martin JA, Hamilton BE, Osterman MJK. Three decades of twin births in the United States, 1980–2009. NCHS Data Brief. 2012;80:1–8.Suche in Google Scholar

[2] Blondel B, Kaminski M. Trends in the occurrence, determinants, and consequences of multiple births. Semin Perinatol. 2002;26:239–49.10.1053/sper.2002.34775Suche in Google Scholar PubMed

[3] Reynolds MA, Schieve LA, Martin JA, Jeng G, Macaluso M. Trends in multiple births conceived using assisted reproductive technology, United States, 1997–2000. Pediatrics. 2003; 111(5 Part 2):1159–66.10.1542/peds.111.S1.1159Suche in Google Scholar

[4] Vayssière C, Benoist G, Blondel B, Deruelle P, Favre R, Gallot D, et al. French College of Gynaecologists and Obstetricians, twin pregnancies: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol. 2011; 156:12–7.10.1016/j.ejogrb.2010.12.045Suche in Google Scholar PubMed

[5] The ESHRE Capri Workshop Group. Multiple gestation pregnancy. Hum Reprod. 2000;15:1856–64.10.1093/humrep/15.8.1856Suche in Google Scholar

[6] Luke B, Brown MB. Contemporary risks of maternal morbidity and adverse outcomes with increasing maternal age and plurality. Fertil Steril. 2007;88:283–93.10.1016/j.fertnstert.2006.11.008Suche in Google Scholar PubMed PubMed Central

[7] Dubé J, Dodds L, Armson BA. Does chorionicity or zygosity predict adverse perinatal outcomes in twins? Am J Obstet Gynecol. 2002;186:579–83.10.1067/mob.2002.121721Suche in Google Scholar PubMed

[8] Sebire NJ, Snijders RJ, Hughes K, Sepulveda W, Nicolaides KH. The hidden mortality of monochorionic twin pregnancies. Br J Obstet Gynaecol. 1997;104:1203–7.10.1111/j.1471-0528.1997.tb10948.xSuche in Google Scholar PubMed

[9] Glinianaia SV, Rankin J, Wright C. Congenital anomalies in twins: a register-based study. Hum Reprod. 2008;23: 1306–11.10.1093/humrep/den104Suche in Google Scholar PubMed

[10] Rossi AC, D’Addario V. Umbilical cord occlusion for selective feticide in complicated monochorionic twins: a systematic review of literature. Am J Obstet Gynecol. 2009;200:123–9.10.1016/j.ajog.2008.08.039Suche in Google Scholar PubMed

[11] Bigelow CA, Factor SH, Moshier E, Bianco A, Eddleman KA, Stone JL. Timing of and outcomes after selective termination of anomalous fetuses in dichorionic twin pregnancies. Prenat Diagn. 2014;34:1320–5.10.1002/pd.4474Suche in Google Scholar PubMed

[12] Alvarado EA, Pacheco RP, Alderete FG, Luís JA, de la Cruz AA, Quintana LO. Selective termination in di-chorionic twins discordant for congenital defect. Eur J Obstet Gynecol Reprod Biol. 2012;161:8–11.10.1016/j.ejogrb.2011.11.024Suche in Google Scholar

[13] Evans MI, Goldberg JD, Dommergues M, Wapner RJ, Lynch L, Dock BS, et al. Efficacy of second trimester selective termination for fetal abnormalities: international collaborative experience among the world’s largest centers. Am J Obstet Gynecol. 1994;171:90–4.10.1016/S0002-9378(94)70083-4Suche in Google Scholar

[14] Bryan E, Little J, Burn J. Congenital anomalies in twins. Baillieres Clin Obstet Gynaecol. 1987;1:697–721.10.1016/S0950-3552(87)80012-3Suche in Google Scholar

[15] Malone FD, Craigo SD, Chelmoy D, D’Alton ME. Outcome of twin gestations complicated by a single anomalous fetus. Obstet Gynecol. 1996;88:1–5.10.1016/0029-7844(96)00112-3Suche in Google Scholar

[16] Nassar AH, Adra AM, Gómez-Marín O, O’Sullivan MJ. Perinatal outcome of twin pregnancies with one structurally affected fetus: a case-control study. J Perinatol. 2000;20:82–6.10.1038/sj.jp.7200318Suche in Google Scholar PubMed

[17] Linskens IH, Elburg RM, Oepkes D, Vugt JM, Haak MC. Expectant management in twin pregnancies with discordant structural fetal anomalies. Twin Res Hum Genet. 2011;14:283–9.10.1375/twin.14.3.283Suche in Google Scholar PubMed

[18] Gul A, Cebeci A, Aslan H, Polat I, Sozen I, Ceylan Y. Perinatal outcomes of twin pregnancies discordant for major fetal anomalies. Fetal Diagn Ther. 2005;20:244–8.10.1159/000085078Suche in Google Scholar PubMed

[19] Sun LM, Chen XK, Wen SW, Fung KF, Yang Q, Walker MC. Perinatal outcomes of normal cotwins in twin pregnancies with one structurally anomalous fetus: a population-based retrospective study. Am J Perinatol. 2009;26:51–6.10.1055/s-0028-1095180Suche in Google Scholar PubMed

[20] Gedikbasi A, Akyol A, Yildirim G, Ekiz A, Gul A, Ceylan Y. Twin pregnancies complicated by a single malformed fetus: chorionicity, outcome and management. Twin Res Hum Genet. 2010;13:501–7.10.1375/twin.13.5.501Suche in Google Scholar PubMed

[21] Chang YL, Chao AS, Cheng PJ, Chung CL, Chueh HY, Chang SD, et al. Presence of a single fetal major anomaly in a twin pregnancy does not increase the preterm rate. Aus N Z J Obstet Gynaecol. 2004;44:332–6.10.1111/j.1479-828X.2004.00248.xSuche in Google Scholar PubMed

[22] Hoyert DL, Mathews TJ, Menacker F, Strobino DM, Guyer B. Annual summary of vital statistics. Pediatrics. 2006;117: 168–83.10.1542/peds.2005-2587Suche in Google Scholar

[23] Gelehrter T, Collins FS, Ginsburg D. Principles of medical genetics. Approach to child with birth defect. 2nd ed. 1998.Suche in Google Scholar

[24] Wood SL, Onge R, Connors G, Elliot PD. Evaluation of the twin peak or Lambda sign in determining chorionicity in multiple pregnancy. Obstet Gynecol. 1996;88:6–9.10.1016/0029-7844(96)00094-4Suche in Google Scholar

[25] Malone FD, D’Alton ME. Management of multiple gestations complicated by a single anomalous fetus. Curr Opin Obstet Gynecol. 1997;17:202–7.10.1097/00001703-199706000-00014Suche in Google Scholar

[26] Lust A, De Catte L, Lewi L, Deprest J, Loquet P, Devlieger R. Monochorionic and dichorionic twin pregnancies discordant for fetal anencephaly: a systematic review of prenatal management options. Prenat Diagn. 2008;28:275–9.10.1002/pd.1967Suche in Google Scholar PubMed

[27] Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc Series B. 1995;57:289–300.10.1111/j.2517-6161.1995.tb02031.xSuche in Google Scholar

[28] Mandy GT, Weisman LE, Kim MS. Neonatal complications, outcome, and management of multiple births. Uptodate 2015. Available at: https://www.uptodate.com/contents/neonatal-complications-outcome-and-management-of-multiple-births?source=search_result&search=Neonatal%20complications,%20outcome,%20and%20management%20of%20multiple%20births.&selectedTitle=1~150.Suche in Google Scholar

[29] Fernandes TR, Carvalho PR, Flosi FB, Baião AE, Junior SC. Perinatal outcome of discordant anomalous twins: a single-center experience in a developing country. Twin Res Hum Genet. 2016;20:1–4.10.1017/thg.2016.42Suche in Google Scholar PubMed

[30] Vandecruys H, Avgidou K, Surerus E, Flack N, Nicolaides KH. Dilemmas in the management of twins discordant for anencephaly diagnosed at 11+0 to 13+6 weeks of gestation. Ultrasound Obstetr Gynecol. 2006;28:653–8.10.1002/uog.2836Suche in Google Scholar PubMed

Received: 2017-01-26
Accepted: 2017-06-12
Published Online: 2017-07-12
Published in Print: 2018-09-25

©2018 Walter de Gruyter GmbH, Berlin/Boston

Artikel in diesem Heft

  1. Frontmatter
  2. Editorial
  3. Antenatal and prepregnancy care – prevention of perinatal morbidity and mortality
  4. Review article
  5. Fetal interventional procedures and surgeries: a practical approach
  6. Opinion paper
  7. Inverted pyramid of prenatal care – is it enough? Should it be – extended inverted pyramid of prenatal care?
  8. Research articles
  9. Expectant management in di-chorionic pregnancies complicated by discordant anomalous twin
  10. Pregnancy outcomes among patients with recurrent pregnancy loss and uterine anatomic abnormalities
  11. Early postnatal echocardiographic assessment of pulmonary blood flow in newborns with congenital diaphragmatic hernia
  12. Sonographic prediction of small and large for gestational age in breech-presenting fetuses
  13. Comparison of fetal weight distribution improved by paternal height by Spanish standard versus Intergrowth 21st standard
  14. Can early ultrasonography explain the lower miscarriage rates in twin as compared to singleton pregnancies following assisted reproduction?
  15. Pregnancy outcomes among patients with recurrent pregnancy loss and chromosomal aberration (CA) without PGD
  16. Regular research articles
  17. Induction of labor in twin gestation: can we predict success?
  18. Low dose aspirin for preventing fetal growth restriction: a randomised trial
  19. Mid-pregnancy cervical length as a risk factor for cesarean section in women with twin pregnancies
  20. Efficacy of three different regimens in recovery of bowel function following elective cesarean section: a randomized trial
  21. Obstetrical, maternal and neonatal outcomes in pregnancies affected by muscular dystrophy
  22. Fetal brain development in diabetic pregnancies and normal controls
  23. Body composition in preterm infants with intrauterine growth restriction: a cohort study
  24. Commentary
  25. Professionally responsible management of gynecologic cancer in pregnancy when clinical resources are unavoidably limited
  26. Letters to the Editor
  27. Erroneous conclusion due to mis-calculation of data: reply to Rai SE, Sidhu AK, Krishnan RJ. Transfusion-associated necrotizing enterocolitis re-evaluated: a systematic review and meta-analysis. J Perinat Med 2017
  28. Reply to: Letter to the Editor by Stritzke A and Shah PS. Transfusion-associated necrotizing enterocolitis re-evaluated: a systematic review and meta-analysis
  29. Congenital Zika syndrome in non-endemic regions
  30. Reply to: Congenital Zika syndrome in non-endemic regions: A neuroimaging pattern-based approach
Heruntergeladen am 21.10.2025 von https://www.degruyterbrill.com/document/doi/10.1515/jpm-2017-0032/html?lang=de
Button zum nach oben scrollen