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Am J Obstet Gynecol. 2010 Aug;203(2):133.e1-6. doi: 10.1016/j.ajog.2010.02.066. Epub 2010 Jun 26.

Contemporary management of monochorionic diamniotic twins: outcomes and delivery recommendations revisited.

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1
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA 02115, USA. nasmith@partners.org

Abstract

OBJECTIVE:

We sought to investigate outcomes of contemporaneously managed monochorionic diamniotic (MCDA) twins, stratified by pregnancy complication.

STUDY DESIGN:

Four hundred eighteen MCDA pregnancies from 2001 through 2008 were retrospectively reviewed.

RESULTS:

There were 236 ongoing pregnancies at 24 weeks' gestation. The likelihood of progressing from 24 weeks to 2 live births was 98.7% in uncomplicated pregnancies, 89.7% with twin-twin transfusion syndrome, and 100% with growth discordance, increasing at 32 weeks to 99.5%, 93.8%, and 100%, respectively. The relative risk (RR) of birth <32 weeks was significantly greater in twin-twin transfusion syndrome (RR, 4.1; 95% confidence interval, 2.7-6.1) and growth discordant (RR, 2.1; 95% confidence interval, 1.8-3.8) pregnancies than in uncomplicated pregnancies (P < .0001).

CONCLUSION:

This represents one of the largest cohorts of MCDA twins. The risk of third-trimester fetal loss was low. The likelihood of both intrauterine fetal demise and preterm birth were greater in complicated pregnancies. In the absence of a clinical indication for delivery, these data do not support elective preterm delivery for prevention of intrauterine fetal demise in uncomplicated MCDA twins.

PMID:
20579959
DOI:
10.1016/j.ajog.2010.02.066
[Indexed for MEDLINE]
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