title: Prospective study of the MD-twin score for antepartum evaluation of monochorionic diamniotic twins and its correlation with perinatal outcomes.
abstract: OBJECTIVE
  To assess the outcome of monochorionic diamniotic (MD) twins with the aid of the MD-twin score.
  
  
  METHODS
  We enrolled 112 MD-twin women in a tertiary perinatal center from 1997 to 2009. The MD-twin score was prospectively applied once per week to women who did not have twin-to-twin transfusion syndrome (TTTS) after 26 weeks of gestation. The MD-twin score consists of five variables: (i) fetal weight discordance; (ii) amniotic fluid discordance; (iii) hydrops fetalis; (iv) umbilical cord insertion; and (v) fetal heart rate monitoring. Normal was assigned a value of 0, abnormal was assigned 1, and total score was used for evaluation. Women with scores of 2 at 26 weeks gestation were managed expectantly until the score reached 3. Outcome measures were fetal death, neonatal death and neurological sequelae. The incidence of poor outcome according to score was investigated. The characteristics of MD twins with poor outcome were investigated.
  
  
  RESULTS
  MD-twin scores were applied to 90 women. Among them, 79 had scores of 2 or less and all had good outcomes. There were 11 women with a score of 3, four of whom had adverse outcome for at least one twin. Neonates born to women with scores of 0-2 had good outcomes without respect to birthweight percentile, while neonates with scores of 3 had poor outcomes when their birthweight percentile was less than the third percentile.
  
  
  CONCLUSIONS
  The MD-twin score is applicable to 90% of MD twins without TTTS. An MD-twin score of 2 is reassuring, while a score of 3 indicates increased risks for adverse outcome.
authors: Perinatal Center, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
authors: Masanao
authors: M
authors: Oohashi
authors: Masatoki
authors: M
authors: Kaneko
authors: Hiroshi
authors: H
authors: Sameshima
authors: Yuki
authors: Y
authors: Kodama
authors: Tsuyomu
authors: T
authors: Ikenoue
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005315:Fetal Diseases / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology*; D007564:Japan / Q000453:epidemiology; D008297:Male; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D018743:Perinatal Care; D011247:Pregnancy; D011256:Pregnancy Outcome; D059285:Pregnancy, Twin; D011446:Prospective Studies; D012306:Risk; D055815:Young Adult
keywords: antepartum surveillance; monochorionic diamniotic twin neurological deficit; perinatal outcome