The "stuck twin" phenomenon: ultrasonographic findings, pregnancy outcome, and management with serial amniocenteses.
Thirteen consecutive twin pregnancies affected by the "stuck twin" phenomenon were reviewed to determine the potential benefit of serial amniocenteses. The fetal survival rate for the eight pregnancies that underwent serial amniocenteses was 69% (11 of 16 fetuses). This is significantly improved compared with a fetal survival rate of 20% among the five preceding pregnancies managed without serial amniocenteses at the same institution (p = 0.01). It is also markedly improved compared with a combined fetal survival rate of 16% among 48 previously reported pregnancies with the stuck twin phenomenon managed without serial amniocenteses (p less than 0.0001). Survival correlated with the absence of concomitant pregnancy complications (i.e., maternal hypertension or intractable labor) and with the absence of severe fetal structural abnormalities. Procedural complications occurred in three of eight pregnancies (37.5%) managed with serial amniocenteses and was attributed as a cause of fetal death in one case. Two of 11 survivors (18%) had complications after serial amniocenteses including brain infarction and renal tubular necrosis. Serial amniocenteses may significantly improve the survival rate of twin gestations affected by the stuck twin phenomenon but may be associated with complications among survivors.
Mahony
B S
BS
Division of Perinatal Medicine, Swedish Hospital Medical Center, Seattle, WA.
Petty
C N
CN
Nyberg
D A
DA
Luthy
D A
DA
Hickok
D E
DE
Hirsch
J H
JH
D000649:Amniocentesis / Q000009:adverse effects / Q000379:methods; D002544:Cerebral Infarction / Q000209:etiology; D004200:Diseases in Twins; D005260:Female; D005313:Fetal Death / Q000209:etiology; D005315:Fetal Diseases / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D005328:Fetal Viability; D006801:Humans; D007683:Kidney Tubular Necrosis, Acute / Q000209:etiology; D016104:Oligohydramnios / Q000000981:diagnostic imaging / Q000628:therapy; D006831:Polyhydramnios / Q000000981:diagnostic imaging / Q000628:therapy; D011247:Pregnancy; D011256:Pregnancy Outcome; D015996:Survival Rate; D016216:Ultrasonography, Prenatal