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Pregnancy Outcome of Monochorionic Twins: Does Amnionicity Matter?

Published online by Cambridge University Press:  21 February 2012

Thiran Dias ,
Elena Contro ,
Basky Thilaganathan ,
Hina Khan ,
Cristina Zanardini ,
Samina Mahsud-Dornan  and
Amar Bhide
Thiran Dias
Affiliation:
Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's University of London, United Kingdom
Elena Contro
Affiliation:
Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's University of London, United Kingdom
Basky Thilaganathan
Affiliation:
Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's University of London, United Kingdom
Hina Khan
Affiliation:
Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's University of London, United Kingdom
Cristina Zanardini
Affiliation:
Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's University of London, United Kingdom
Samina Mahsud-Dornan
Affiliation:
Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's University of London, United Kingdom
Amar Bhide*
Affiliation:
Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's University of London, United Kingdom
*
ADDRESS FOR CORRESPONDENCE: Dr Amar Bhide, Fetal Medicine Unit, St George's Hospital, Blackshaw Road, SW17 9QT London UK. E-mail: abhide@sgul.ac.uk

Abstract

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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.

Type
Articles
Information
Twin Research and Human Genetics , Volume 14 , Issue 6 , December 2011 , pp. 586 - 592
Copyright
Copyright © Cambridge University Press 2011

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