title: Outcome of monochorionic twin pregnancies with moderate amniotic fluid discordance adjoining twin-twin transfusion syndrome.
abstract: OBJECTIVE
  This study aimed to assess the perinatal outcome in monochorionic diamniotic (MD) twin pregnancies complicated by amniotic fluid discordance (AFD) adjoining twin-twin transfusion syndrome (TTTS).
  
  
  METHODS
  An observational study of 84 consecutive MD twin pregnancies complicated by AFD that resembled TTTS was conducted. AFD adjoining TTTS was defined by a maximal vertical pocket of amniotic fluid ≤3 cm in one twin and ≥7 cm in the other excluding TTTS. The study population was divided into two groups, group 1 and group 2, according to positive and absent or reversed end-diastolic flow (AREDF) in the umbilical artery, respectively.
  
  
  RESULTS
  Fifteen of the 35 (42.9%) group 1 cases and 30 of the 49 (61.2%) group 2 cases progressed to TTTS. The overall survival and intact survival rate in constant AFD that never progressed to TTTS in group 1 was 100% (40/40) and 90% (36/40), respectively. The overall survival and intact survival rate of constant AFD in group 2 with selective intrauterine growth restriction (sIUGR) was 54.2% (13/24) and 41.7% (10/24), respectively, and for those without sIUGR was 64.3% (9/14) and 57.1% (8/14), respectively.
  
  
  CONCLUSIONS
  Constant AFD with AREDF in the umbilical artery represents an extremely high risk for adverse outcomes regardless of the presence of sIUGR.
authors.affiliation: Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hayashi
authors.affiliation: Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.|Department of Obstetrics and Gynecology, National Hospital Organization Beppu Medical Center, Beppu, Japan.
authors.forename: Ai
authors.initials: A
authors.lastname: Anami
authors.affiliation: Maternal Fetal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Ishii
authors.affiliation: Department of Biostatistics, Graduate school of Medicine, Yokohama City University, Yokohama, Japan.
authors.forename: Mari S
authors.initials: MS
authors.lastname: Oba
authors.affiliation: Department of Fetal-Maternal Medicine, Nagara Medical Center, Gifu, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Nakata
authors.affiliation: Department of Obstetrics, Miyagi Children's Hospital, Sendai, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Murotsuki
authors.affiliation: Division of Perinatology, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Murakoshi
authors.affiliation: Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Sago
mesh_terms: D000653:Amniotic Fluid / Q000000981:diagnostic imaging*; D002823:Chorion / Q000000981:diagnostic imaging*; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging / Q000401:mortality*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D066087:Perinatal Death; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D059285:Pregnancy, Twin; D047928:Premature Birth; D012189:Retrospective Studies; D014430:Twins, Monozygotic