American Journal of Obstetrics & Gynecology
Volume 200, Issue 5 , Pages 494.e1-494.e8 , May 2009

The pregnancy and long-term neurodevelopmental outcome of monochorionic diamniotic twin gestations: a multicenter prospective cohort study from the first trimester onward

Presented as an oral communication at the 29th Annual Scientific Meeting of the Society for Maternal–Fetal Medicine, San Diego, CA, Jan. 26-31, 2009.

  • Els Ortibus, MD

      Affiliations

    • Department of Pediatrics, University Hospitals, Leuven, Belgium
    • ,
  • Enrico Lopriore, MD, PhD

      Affiliations

    • Department of Pediatrics, Leiden University Medical Centre, Leiden, the Netherlands
    • ,
  • Jan Deprest, MD, PhD

      Affiliations

    • Department of Obstetrics and Gynecology, University Hospitals, Leuven, Belgium
    • ,
  • Frank P. Vandenbussche, MD, PhD

      Affiliations

    • Department of Obstetrics and Gynecology, Leiden University Medical Centre, Leiden, the Netherlands
    • ,
  • Frans J. Walther, MD, PhD

      Affiliations

    • Department of Pediatrics, Leiden University Medical Centre, Leiden, the Netherlands
    • ,
  • Anke Diemert, MD

      Affiliations

    • Department of Obstetrics and Gynecology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
    • ,
  • Kurt Hecher, MD, PhD

      Affiliations

    • Department of Obstetrics and Gynecology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
    • ,
  • Lieven Lagae, MD, PhD

      Affiliations

    • Department of Pediatrics, University Hospitals, Leuven, Belgium
    • ,
  • Paul De Cock, MD, PhD

      Affiliations

    • Department of Pediatrics, University Hospitals, Leuven, Belgium
    • ,
  • Paul J. Lewi, PhD, Eng

      Affiliations

    • Department of Obstetrics and Gynecology, University Hospitals, Leuven, Belgium
    • ,
  • Liesbeth Lewi, MD, PhD

      Affiliations

    • Department of Obstetrics and Gynecology, University Hospitals, Leuven, Belgium

Received 25 November 2008 ,Revised 15 January 2009 ,Accepted 23 January 2009.

References 

  1. Dubé J, Dodds L, Armson A. Does chorionicity or zygosity predict adverse perinatal outcomes in twins?. Am J Obstet Gynecol. 2002;186:479–583
  2. Sebire NJ, Snijders RJ, Hughes K, Sepulveda W, Nicolaides KH. The hidden mortality of monochorionic twin pregnancies. Br J Obstet Gynecol. 1997;104:1203–1207
  3. Denbow ML, Cox P, Taylor M, Hammal DM, Fisk NM. Placental angioarchitecture in monochorionic twin pregnancies: relationship to fetal growth, fetofetal transfusion syndrome, and pregnancy outcome. Am J Obstet Gynecol. 2000;182:417–426
  4. Lewi L, Van Schoubroek D, Gratacos E, Witters I, Timmermans D, Deprest J. Monochorionic diamniotic twins: complications and management. Curr Opin Obstet Gynecol. 2003;15:177–194
  5. Lopriore E, Middeldorp JM, Sueters M, Oepkes D, Vandenbussche FP, Walther FJ. Long-term neurodevelopmental outcome in twin-to-twin transfusion syndrome treated with fetoscopic laser surgery. Am J Obstet Gynecol. 2007;196:231.e1–231.e4
  6. Graef C, Ellenrieder B, Hecher K, Hackeloer BJ, Huber A, Bartmann P. Long-term neurodevelopmental outcome of 167 children after intrauterine laser treatment for severe twin-twin transfusion syndrome. Am J Obstet Gynecol. 2006;194:303–308
  7. Adegbite AL, Castille S, Ward S, Bajoria R. Neuromorbidity in preterm twins in relation to chorionicity and discordant birth weight. Am J Obstet Gynecol. 2004;190:156–163
  8. Ong SS, Zamora J, Khan KS, Kilby MD. Prognosis for the co-twin following single-twin death: a systematic review. BJOG. 2006;113:992–998
  9. Carroll SG, Soothill PW, Abdel-Fattah SA, Porter H, Montague I, Kyle PM. Prediction of chorionicity in twin pregnancies at 10-14 weeks of gestation. BJOG. 2002;109:182–186
  10. Senat MV, Deprest J, Boulvain M, Paupe A, Winer N, Ville Y. Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. N Engl J Med. 2004;351:136–144
  11. Lewi L, Gratacos E, Van Schoubroeck D, et al. Pregnancy and infant outcome of 80 consecutive cord coagulations in monochorionic multiple pregnancies: a prospective follow-up study. Am J Obstet Gynecol. 2006;194:782–789
  12. Van der Meulen BF, Ruiter SAJ, Spelberg HCL, Smrkovsky M. Bayley scales of infant development. 2nd ed (BSID-II). Bayley N. Dutch version. 2002.
  13. Bayley N. Bayley scales of infant development. 2nd ed.. 1993;San Antonio, TX
  14. Tellegen PJ, Winkel M, Wijnberg-Williams BJ, Laros JA. Snijders-Oomen niet-verbale intelligentietest: SON-R 2 ½-7. 1998;
  15. Folio M, Fewell RR. Peabody developmental motor scale. 2nd ed.. 2000;Austin, TX
  16. Surveillance of Cerebral Palsy in Europe (SCPE). Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Dev Med Child Neurol. 2000;42:816–824
  17. Lewi L, Jani J, Blickstein I, et al. The outcome of monochorionic diamniotic twin gestations in the era of invasive fetal therapy: a prospective cohort study. Am J Obstet Gynecol. 2008;199:514.e1–514.e8
  18. Lewi L, Lewi P, Diemert A, et al. The role of ultrasound examination in the 1st trimester and at 16 weeks' gestation to predict fetal complications in monochorionic diamniotic twin pregnancies. Am J Obstet Gynecol. 2008;199:493.e1–493.e7
  19. Gratacos E, Lewi L, Munoz B, et al. A classification system for selective intrauterine growth restriction in monochorionic pregnancies according to umbilical artery Doppler flow in the smaller twin. Ultrasound Obstet Gynecol. 2007;30:28–34
  20. Lewi L, Cannie M, Blickstein I, et al. Placental sharing, birthweight discordance and vascular anastomoses in monochorionic diamniotic twin placentas. Am J Obstet Gynecol. 2007;197:587.e1–587.e8
  21. Lewi L, Gucciardo L, Huber A, et al. Clinical outcome and placental characteristics of monochorionic diamniotic twin pairs with early and late onset discordant growth. Am J Obstet Gynecol. 2008;199:511.e1–511.e7
  22. Lopriore E, Stroeken H, Sueters M, Meerman RJ, Walther F, Vandenbussche F. Term perinatal mortality and morbidity in monochorionic and dichorionic twin pregnancies: a retrospective study. Acta Obstet Gynecol Scand. 2008;87:541–545
  23. Lopriore E, Slaghekke F, Vandenbussche FP, Middeldorp JM, Walther FJ, Oepkes D. Cerebral injury in monochorionic twins with selective intrauterine growth restriction and/or birthweight discordance. Am J Obstet Gynecol. 2008;199:628.e1–628.e5
  24. Acosta-Rojas R, Becker J, Munoz-Abellana B, Ruiz C, Carreras E, Gratacos E Catalunya and Balears Monochorionic Network. Twin chorionicity and the risk of adverse perinatal outcome. Int J Gynaecol Obstet. 2007;96:98–102
  25. Huber A, Diehl W, Bregenzer T, Hackeloer BJ, Hecher K. Stage-related outcome in twin-twin transfusion syndrome treated by fetoscopic laser coagulation. Obstet Gynecol. 2006;108:333–337
  26. Middeldorp JM, Sueters M, Lopriore E, et al. Fetoscopic laser surgery in 100 pregnancies with severe twin-to-twin transfusion syndrome in the Netherlands. Fetal Diagn Ther. 2007;22:190–194
  27. Quintero RA, Dickinson JE, Morales WJ, et al. Stage-based treatment of twin-twin transfusion syndrome. Am J Obstet Gynecol. 2003;188:1333–1340
  28. Gratacós E, Lewi L, Carreras E, et al. Incidence and characteristics of umbilical artery intermittent absent and/or reversed end-diastolic flow in complicated and uncomplicated monochorionic twin pregnancies. Ultrasound Obstet Gynecol. 2004;23:456–460
  29. Quintero RA, Bornick PW, Morales WJ, Allen MH. Selective photocoagulation of the communicating vessels in the treatment of monochorionic twins with selective growth retardation. Am J Obstet Gynecol. 2001;185:689–696
  30. Helmerhorst FM, Perquin DA, Donker D, Keirse MJ. Perinatal outcome of singletons and twins after assisted conception: a systematic review of controlled studies. BMJ. 2004;328:261
  31. Chow JS, Benson CB, Racowsky C, Doubilet PM, Ginsburg E. Frequency of a monochorionic pair in multiple gestations: relationship to mode of conception. J Ultrasound Med. 2001;20:757–760
  32. Sperling L, Kiil C, Larsen LU, et al. Naturally conceived twins with monochorionic placentation have the highest risk of fetal loss. Ultrasound Obstet Gynecol. 2006;28:644–652
  33. Minakami H, Honma Y, Matsubara S, Uchida A, Shiraishi H, Sato I. Effects of placental chorionicity on outcome in twin pregnancies: a cohort study. J Reprod Med. 1999;44:595–600
  34. Brouwer SI, van Beijsterveldt TC, Bartels M, Hudziak JJ, Boomsma DI. Influences on achieving motor milestones: a twin-singleton study. Twin Res Hum Genet. 2006;9:424–430
  35. Tieman BL, Palisano RJ, Sutlive AC. Assessment of motor development and function in preschool children. Ment Retard Dev Disabil Res Rev. 2005;11:189–196
  36. Pharoah PO. Risk of cerebral palsy in multiple pregnancies. Clin Perinatol. 2006;33:301–313
  37. Adegbite AL, Castille S, Ward S, Bajoria R. Prevalence of cranial scan abnormalities in preterm twins in relation to chorionicity and discordant birthweight. Eur J Obstet Gynaecol Reprod Biol. 2005;119:47–55
  38. Cincotta RB, Gray PH, Phythian G, Rogers YM, Chan FY. Long term outcome of twin-twin transfusion syndrome. Arch Dis Child Fetal Neonatal Ed. 2000;83:F171–F176
  39. Lopriore E, Nagel HT, Vandenbussche FP, Walther FJ. Long-term neurodevelopmental outcome in twin-twin transfusion syndrome. Am J Obstet Gynecol. 2003;189:1314–1319

 Reprints not available from the authors.

 Dr L. Lewi is the recipient of a Grant of the 5th Framework Program of the European Commission (#QLG1-CT-2002-01632 EuroTwin2Twin). Dr Deprest is the recipient of a Fundamental Clinical Researcher Grant of the Fonds Wetenschappelijk Onderzoek (FWO)-(1.8.012.07.N.02).

 Cite this article as: Ortibus E, Lopriore E, Deprest J, et al. The pregnancy and long-term neurodevelopmental outcome of monochorionic diamniotic twin gestations: a multicenter prospective cohort study from the first trimester onward. Am J Obstet Gynecol 2009;200:494.e1-494.e8.

PII: S0002-9378(09)00115-X

doi: 10.1016/j.ajog.2009.01.048

American Journal of Obstetrics & Gynecology
Volume 200, Issue 5 , Pages 494.e1-494.e8 , May 2009

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