Objective: To study the incidence and mortality and morbidity rates of twin-twin transfusion syndrome in a complete population-based cohort in Nova Scotia.
Methods: A population-based cohort study of all monochorionic diamniotic twin pregnancies of 20 weeks of gestation or longer born to Nova Scotia (Canada) residents between 1988 and 2000 was examined. The effect of gestational age adjustment and birth weight discordancy of more than 20% on mortality and 1-year survival was studied. Other outcomes studied included birth depression, respiratory distress syndrome, chronic lung disease, interventricular hemorrhage, periventricular leukomalacia, acute renal failure, and congestive heart failure.
Results: Of 404 monochorionic-diamniotic twin pregnancies examined, 48 were identified with twin-twin transfusion syndrome. Total mortality rates per pregnancy were significantly greater in the twin-twin transfusion syndrome group than in the remainder of our monochorionic diamniotic population (P < .01). However, when adjusted for gestational age, mortality failed to achieve statistical significance. Similarly, no differences were noted for 1-year survival and other outcomes of liveborn infants after gestational age adjustment. Discordance in birth weight predicted a higher incidence of morbid outcomes per pregnancy, but this effect was lost after gestational age adjustment.
Conclusion: Increased morbidity and mortality of twins with twin-twin transfusion syndrome is likely to be due to a higher incidence of preterm birth. Birth weight discordancy was not found to be an independent predictor of mortality after controlling for gestational age and twin-twin transfusion syndrome.
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http://dx.doi.org/10.1097/01.AOG.0000143828.41271.6c | DOI Listing |
Eur J Obstet Gynecol Reprod Biol
January 2025
Baylor College of Medicine Houston TX, United States.
Objective: Monochorionic diamniotic (MCDA) twins with amniotic fluid abnormalities that do not meet criteria for twin-twin transfusion syndrome (TTTS) concern physicians and families. This study aimed to describe the natural history of amniotic fluid abnormalities.
Methods: In this retrospective case-control study, TTTS screening ultrasounds and clinical records throughout all MCDA twin gestations were reviewed between 2018 and 2022 at a tertiary fetal care center.
Obstet Gynecol
January 2025
Riley Children's, the Division of Maternal-Fetal Medicine, Indiana University Health Fetal Center, and the Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana; the Division of Maternal-Fetal Medicine and Surgery, Fetal Care and Surgery Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; the Department of Obstetrics and Gynecology, Brown University Medical School, Providence, Rhode Island; the Fetal Medicine Unit, St George's Hospital, St George's University of London, London, United Kingdom; the Division of Maternal-Fetal Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania; and the Division of Maternal-Fetal Medicine, The Ohio State University, Columbus, Ohio.
Objective: To investigate short-term maternal and neonatal outcomes in individuals with twin pregnancies and two prior cesarean deliveries who underwent trial of labor after cesarean (TOLAC).
Methods: A cross-sectional study of live-birth data was conducted between 2014 and 2021 in the United States. Individuals with more than two prior cesarean deliveries and multiple gestations higher than twins were excluded.
Prenat Diagn
January 2025
Department of Preventive Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
Introduction: Fetoscopic laser surgery (FLS) is the gold standard treatment for monochorionic (MC) twin pregnancies complicated by twin-twin transfusion syndrome (TTTS). The aim of our study was to evaluate the rate and risk factors for cord entanglement in the presence of iatrogenic monoamnioticity (iMA), a consequence of inadvertent septostomy during FLS.
Methods: This is a retrospective analysis of two consecutive cohorts of FLS performed either using the selective technique from January 2004 to January 2012, or with the Solomon technique, from that date onwards.
Taiwan J Obstet Gynecol
January 2025
Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address:
Objective: To describe a rare case of a retroperitoneal Müllerian cyst in a teenage girl with a protruding uterus and associated urogenital anomalies, and to discuss the challenges faced in differential diagnosis and management of such cases.
Case Report: We present the case of a 14-year-old girl presented with a protruding uterus for several weeks, with a history of twin-twin transfusion syndrome at birth. Initial ultrasonography identified a large pelvic cystic tumor.
Am J Obstet Gynecol
January 2025
Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, United Kingdom; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom; Twin and Multiple Pregnancy Centre for Research and Clinical Excellence, St George's University Hospital, St George's University of London, London, UK; Fetal Medicine Unit, Liverpool Women's Hospital, Liverpool, United Kingdom. Electronic address:
Objective: The objective of this study was to conduct a longitudinal assessment of inter-twin growth and Doppler discordance, to identify possible distinct patterns, and to investigate the predictive value of longitudinal discordance patterns for adverse perinatal outcomes in twin pregnancies.
Methods: This retrospective cohort study included twin pregnancies followed and delivered at a tertiary University Hospital in London (UK), between 2010 and 2023. We included pregnancies with at least three ultrasound assessments after 18 weeks and delivery after 34 weeks' gestation.
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