title: Perinatal outcome of monochorionic diamniotic twin pregnancies managed from early gestation at a single center.
abstract: OBJECTIVE
  The aim of this study was to evaluate the perinatal outcome of monochorionic diamniotic (MD) twin gestations managed from early gestation onward at a single center.
  
  
  METHODS
  This was a retrospective single-cohort study, spanning 6 years, of 219 MD twin pregnancies who received prenatal care before 14 weeks of gestation and delivered at our center. The subjects were all under the same perinatal management protocol. The incidence of fetal or neonatal death, major neurological complications at 28 days of age, twin-twin transfusion syndrome (TTTS), twin anemia-polycythemia sequence, and discordant birth was evaluated. Laser surgery was offered for TTTS at less than 26 weeks; however, selective feticide was not performed.
  
  
  RESULTS
  Pregnancy termination was selected in two cases. Miscarriage occurred in two (1%) of the cases and preterm delivery occurred in 91 (42%). In regard to perinatal outcome at 28 days of age, 195 (89%) women possessed two live infants and 205 (94%) possessed at least one live infant. The overall survival rate was 92% (403/438). The prevalence of TTTS was 17 cases (8%), seven of whom underwent laser surgery. Four cases of twin anemia-polycythemia sequence were diagnosed postnatally (2%); discordant birth was diagnosed in 24 (12%). Major neonatal neurological abnormalities were noted in six cases (2%).
  
  
  CONCLUSIONS
  The incidence of perinatal complications in 219 sets of MD twins managed from early gestational age to the neonatal period in one perinatal center was demonstrated. The incidence of TTTS was 8%; the survival rate was 89% at 28 days of age.
authors.affiliation: Department of Maternal Fetal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Nakayama
authors.forename: Keisuke
authors.initials: K
authors.lastname: Ishii
authors.forename: Haruna
authors.initials: H
authors.lastname: Kawaguchi
authors.forename: Shusaku
authors.initials: S
authors.lastname: Hayashi
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Hidaka
authors.forename: Takeshi
authors.initials: T
authors.lastname: Murakoshi
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Mitsuda
mesh_terms: D000740:Anemia / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005330:Fetofetal Transfusion / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D011086:Polycythemia / Q000453:epidemiology; D011247:Pregnancy; D012189:Retrospective Studies; D014430:Twins, Monozygotic