American Journal of Obstetrics & Gynecology
Volume 199, Issue 5 , Pages 514.e1-514.e8 , November 2008

The outcome of monochorionic diamniotic twin gestations in the era of invasive fetal therapy: a prospective cohort study

Presented at the 17th World Congress on Ultrasound in Obstetrics and Gynecology, Florence, Italy, Oct. 7-11, 2007.

  • Liesbeth Lewi, MD

      Affiliations

    • Departments of Obstetrics and Gynecology, University Hospitals, Leuven, Belgium
    • ,
  • Jacques Jani, MD, PhD

      Affiliations

    • Departments of Obstetrics and Gynecology, University Hospitals, Leuven, Belgium
    • ,
  • Isaac Blickstein, MD

      Affiliations

    • Kaplan Medical Center, Rehovot, Israel
    • ,
  • Agnes Huber, MD

      Affiliations

    • Universitätsklinikum Hamburg-Eppendorf, Germany
    • ,
  • Leonardo Gucciardo, MD

      Affiliations

    • Departments of Obstetrics and Gynecology, University Hospitals, Leuven, Belgium
    • ,
  • Tim Van Mieghem, MD

      Affiliations

    • Departments of Obstetrics and Gynecology, University Hospitals, Leuven, Belgium
    • ,
  • Elisa Doné, MD

      Affiliations

    • Departments of Obstetrics and Gynecology, University Hospitals, Leuven, Belgium
    • ,
  • Anne-Sophie Boes, MD

      Affiliations

    • Departments of Obstetrics and Gynecology, University Hospitals, Leuven, Belgium
    • ,
  • Kurt Hecher, MD, PhD

      Affiliations

    • Universitätsklinikum Hamburg-Eppendorf, Germany
    • ,
  • Eduardo Gratacós, MD, PhD

      Affiliations

    • Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
    • ,
  • Paul Lewi, PhD

      Affiliations

    • Departments of Obstetrics and Gynecology, University Hospitals, Leuven, Belgium
    • ,
  • Jan Deprest, MD, PhD

      Affiliations

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

Received 26 August 2007 ,Revised 21 December 2007 ,Accepted 21 March 2008.

References 

  1. Sebire NJ, Snijders RJ, Hughes K, Sepulveda W, Nicolaides KH. The hidden mortality of monochorionic twin pregnancies. Br J Obstet Gynaecol. 1997;104:1203–1207
  2. Acosta-Rojas R, Becker J, Munoz-Abellana B, et al. Twin chorionicity and the risk of adverse perinatal outcome. Int J Gynaecol Obstet. 2007;96:98–102
  3. Lewi L, Van Schoubroeck D, Gratacos E, Witters I, Timmerman D, Deprest J. Monochorionic diamniotic twins: complications and management options. Curr Opin Obstet Gynecol. 2003;15:177–194
  4. Fick AL, Feldstein VA, Norton ME, Wassel Fyr C, Caughey AB, Machin GA. Unequal placental sharing and birth weight discordance in monochorionic diamniotic twins. Am J Obstet Gynecol. 2006;195:178–183
  5. 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
  6. Lewi L, Gratacos E, Ortibus E, et al. Pregnancy and infant outcome of 80 consecutive cord coagulations in complicated monochorionic multiple pregnancies. Am J Obstet Gynecol. 2006;194:782–789
  7. Sepulveda W, Sebire NJ, Hughes K, Odibo A, Nicolaides KH. The lambda sign at 10-14 weeks of gestation as a predictor of chorionicity in twin pregnancies. Ultrasound Obstet Gynecol. 1996;7:421–423
  8. 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
  9. Lopriore E, Middeldorp JM, Oepkes D, Kanhai HH, Walther FJ, Vandenbussche FP. Twin anemia-polycythemia sequence in two monochorionic twin pairs without oligo-polyhydramnios sequence. Placenta. 2007;28:47–51
  10. Quintero RA, Morales WJ, Allen MH, Bornick PW, Johnson PK, Kruger M. Staging of twin-twin transfusion syndrome. J Perinatol. 1999;19:550–555
  11. Barigye O, Pasquini L, Galea P, Chambers H, Chappell L, Fisk NM. High risk of unexpected late fetal death in monochorionic twins despite intensive ultrasound surveillance: a cohort study. PLoS Med. 2005;2:e172
  12. Simões T, Amaral N, Lerman R, Ribeiro F, Dias E, Blickstein I. Prospective risk of intrauterine death of monochorionic-diamniotic twins. Am J Obstet Gynecol. 2006;195:134–139
  13. 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
  14. 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
  15. Quintero RA, Dickinson JE, Morales WJ, et al. Stage-based treatment of twin-twin transfusion syndrome. Am J Obstet Gynecol. 2003;188:1333–1340
  16. Sperling L, Kiil C, Larsen LU, et al. Detection of chromosomal abnormalities, congenital abnormalities and transfusion syndrome in twins. Ultrasound Obstet Gynecol. 2007;29:517–526
  17. Baldwin VJ. Anomalous development in twins. In:  Baldwin VJ editors. Pathology of multiple pregnancies. New York: Springer-Verlag; 1994;p. 169–197
  18. Bryan E, Little J, Burn J. Congenital anomalies in twins. Baillieres Clin Obstet Gynaecol. 1987;1:697–721
  19. Machin GA. Some causes of genotypic and phenotypic discordance in monozygotic twin pairs. Am J Med Genet. 1996;61:216–228
  20. Quarello E, Molho M, Ville Y. Incidence, mechanisms, and patterns of fetal cerebral lesions in twin-to-twin transfusion syndrome. J Matern Fetal Neonatal Med. 2007;589–597
  21. Karatza AA, Wolfenden JL, Taylor MJ, Wee L, Fisk NM, Gardiner HM. Influence of twin-twin transfusion syndrome on fetal cardiovascular structure and function: prospective case-control study of 136 monochorionic twin pregnancies. Heart. 2002;88:271–277
  22. Lewi L, Jani J, Cannie M, et al. Intertwin anastomoses in monochorionic placentas after fetoscopic laser coagulation for twin-to-twin transfusion syndrome: is there more than meets the eye?. Am J Obstet Gynecol. 2006;194:790–795
  23. Robyr R, Lewi L, Salomon LJ, et al. Prevalence and management of late fetal complications following successful selective laser coagulation of chorionic plate anastomoses in twin-to-twin transfusion syndrome. Am J Obstet Gynecol. 2006;194:796–803

 Cite this article as: 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. Am J Obstet Gynecol 2008;199:514.e1-514.e8.

 Reprints not available from the authors.

 Drs L. Lewi, Jani, and Huber are the recipients of a grant of the Fifth Framework Program of the European Commission (#QLG1-CT-2002-01632 EuroTwin2Twin). Dr Doné is the recipient of a grant within the Marie Curie Program of the European Commission (MEST CT2005 019707).

PII: S0002-9378(08)00345-1

doi: 10.1016/j.ajog.2008.03.050

American Journal of Obstetrics & Gynecology
Volume 199, Issue 5 , Pages 514.e1-514.e8 , November 2008

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