Contemporary management of monochorionic diamniotic twins: outcomes and delivery recommendations revisited.
OBJECTIVE
We sought to investigate outcomes of contemporaneously managed monochorionic diamniotic (MCDA) twins, stratified by pregnancy complication.


METHODS
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).


CONCLUSIONS
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.
Smith
Nicole A
NA
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA 02115, USA. nasmith@partners.org
Wilkins-Haug
Louise
L
Santolaya-Forgas
Joaquin
J
Acker
David
D
Economy
Katherine E
KE
Benson
Carol B
CB
Robinson
Julian N
JN
D000328:Adult; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods*; D004200:Diseases in Twins / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D005260:Female; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D008423:Maternal Age; D008428:Maternal Mortality / Q000639:trends; D007752:Obstetric Labor, Premature / Q000453:epidemiology / Q000628:therapy; D010298:Parity; D054238:Perinatal Mortality / Q000639:trends; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D050497:Stillbirth; D014430:Twins, Monozygotic; D016216:Ultrasonography, Prenatal; D055815:Young Adult