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Am J Perinatol 2001; 18(1): 023-038
DOI: 10.1055/s-2001-12937
DOI: 10.1055/s-2001-12937
Adverse Perinatal Outcome of Twin Pregnancies According to Chorionicity: Review of the Literature
Further Information
Publication History
Publication Date:
31 December 2001 (online)
ABSTRACT
Twin gestations are at significant increased risk for adverse perinatal outcome. As a result, although prospective randomized data is lacking, increased fetal surveillance has been advocated for twins. Growth concordance is considered a reassuring sign in twins and conversely, discordancy to possibly reflect a hostile intrauterine environment at least to the smaller twin. Consequently, increased surveillance of discordant twins is commonly practiced. Monochorionic twins are at further risk for type-specific perinatal complications, for example, twin-twin transfusion syndrome. Recently, precise first-trimester depiction of chorionicity has enabled early antepartum stratification of twin gestations according to chorionicity, in comparison with previous later (mid- and third-trimester) ultrasonographic diagnosis of chorionicity. This immediately leads to the question whether antenatal testing of twins should differ according to chorionicity? Review of the literature supports that despite the existence of complications unique to monochorionic twin gestations, dichorionic twins sustain an increased risk of adverse perinatal outcome (such as fetal growth restriction) in comparison with singletons, and that close antenatal fetal surveillance of twins should be performed, irrespective of chorionicity.
KEYWORD
Twin gestations - antenatal testing - perinatal outcome - chorionicity
REFERENCES
- 1 Medearis A L, Jonas A S, Stockbauer J W, Domke H R. Perinatal death in twin pregnancy: a five year analysis of statewide statistics in Missouri. Am J Obstet Gynecol . 1979; 134 413-421
- 2 Herruzo A J, Martinez L, Biel E, Robles R, Rosales M A, Miranda J A. Perinatal morbidity and mortality in twin pregnancy. Int J Gynaecol Obstet . 1991; 36 17-22
- 3 Jones J M, Sbarra A J, Cetrulo C L. Antepartum management of twin gestation. Clin Obstet Gynecol . 1990; 33 32-41
- 4 Chitrit Y, Filidori M, Pons J C, Duyme M, Papiernik E. Perinatal mortality in twin pregnancies: a 3 year analysis in Seine Saint-Denis (France). Eur J Obstet Gynecol Reprod Biol . 1999; 86 23-28
- 5 Powers W F, Kiely L. The risks confronting twins: a national perspective. Obstet Gynecol . 1994; 170 456-461
- 6 Spellacy W N, Handler A, Ferre C D. A case control study of 1253 twin pregnancies from a 1982-1987 perinatal data base. Obstet Gynecol . 1990; 75 168-171
- 7 McCullah K. Neonatal problems in twins. Clin Perinatol . 1988; 15 141-158
- 8 Wenstrom K D, Syrop C H, Hammitt D G, Van Voohis J B. Increased risk of monochorionic twinning associated with assisted reproduction. Fertil Steril . 1993; 60 510-514
- 9 Schinzel A A, Smith D W, Miller J R. Monozygotic twins and structural defects. J Pediatr . 1979; 95 921-930
- 10 Rodis J F, Egan J F, Craffey A, Ciarleglio L, Greenstein R M, Scorza W E. Calculated risk of chromosomal abnormalities in twin gestations. Obstet Gynecol . 1990; 76 1037-1041
- 11 Luke B. The changing patterns of multiple births in the United States: maternal and infant characteristics, 1973 and 1990. Obstet Gynecol . 1994; 84 101-106
- 12 Grumbach K, Coleman B G, Arger P H, Mintz M C, Gabbe S V, Mennuti M T. Twin and singleton growth patterns compared using ultrasound. Radiology . 1986; 158 237-241
- 13 Rodis J F, McIlveen P F, Egan J FX, Borgida A F, Turner G W, Campbell W A. Monoamniotic twins: improved perinatal survival with accurate prenatal diagnosis and antenatal surveillance. Am J Obstet Gynecol . 1997; 177 1046-1049
- 14 Loos R, Derom C, Vlietinick R, Derom R. The East Flanders prospective twin survey (Belgium): a population-based register. Twin Research . 1998; 1 167-178
- 15 Derom C, Maes H, Derom R, Van den Berghe H, Vlietinck R. Iatrogenic multiple pregnancies in East Flanders, Belgium. Fertil Steril . 1993; 60 493-496
- 16 Oleszczuk J J, Keith D M, Keith L G. Projections of population-based twinning rates through the year 2100. J Reprod Med . 1999; 44 913-921
- 17 Derom C, Vlietinck R, Derom R. Increased monozygotic twinning after ovulation induction. Lancet . 1987; 1 1236-1238
- 18 Alikani M, Noyes N, Cohen J, Rosenwaks Z. Monozygotic twinning in the human is associated with the zona pellucida architecture. Hum Reprod . 1994; 9 1318-1321
- 19 Gardner M O, Alvarez Amaya M, Sakakini J. Effects of prenatal care on twin gestations. J Reprod Med . 1990; 35 519-521
- 20 Saari-Kemppainen A, Karjalainen O, Ylöstalo P, Heinonen O P. Ultrasound screening and perinatal mortality: controlled trial of systematic one-stage screening in pregnancy. Lancet . 1990; 336 387-391
- 21 Ewigman B G, Crane J P, Frigoletto F D, LeFevre M L, Bain R P, McNellis D. Effect of prenatal ultrasound screening on perinatal outcome. N Engl J Med . 1993; 329 821-827
- 22 Newman R B, Ellings J M. Antepartum management of the multiple gestation: the case for specialized care. Semin Perinatol . 1995; 19 387-403
- 23 Rodis J F, Vintzileos AM,Campbell W A, Nochimson D J. Intrauterine fetal growth in discordant twin gestations. J Ultrasound Med . 1990; 9 443-448
- 24 Sherer D M, Divon M Y. Fetal growth in multiple gestation. Clin Obstet Gynecol . 1997; 40 764-770
- 25 Benirschke K. Multiple gestation: incidence, etiology, and inheritance. In: Creasy RK, Resnik R, eds. Maternal-Fetal Medicine: Principles and Practice
Philadelphia: Saunders 1994: 575-588
MissingFormLabel
- 26 Benirschke K. The biology of the twinning process: how placentation influences outcomes. Semin Perinatol . 1995; 19 342-350
- 27 Derom R, Derom C, Vlietnik R. Placentation. In: Keith LG, Papiernik E, Keith DM, Likue B, eds. Multiple Pregnancy
Vol. 9. London: Parthenon Press 1996: 113-128
MissingFormLabel
- 28 Sebire N J, D'Ercole C, Soarse W, Nayar R, Nicloaides K H. Intertwin disparity in fetal size in monochorionic and dichorionic pregnancies. Obstet Gynecol . 1998; 91 82-85
- 29 Appleman Z, Manor M, Magal N, Caspi B, Shohat M, Blickstein I. Prenatal diagnosis of twin zygosity by DNA fingerprint analysis. Prenat Diagn . 1994; 14 307-309
- 30 Porrini S C, Sciarra A, Sulli N, Piane M, Gualtieri R, Del Porto G. Variable number of tandem repeats in zygosity diagnosis in twins. Acta Genet Med Gemellol . 1990; 39 473-477
- 31 Bessis R, Papiernik E. Echographic imagery of amniotic membranes in twin pregnancies. In: Gedda L, Parisi P, eds. Twin Research, Vol Twin Biology and Multiple Pregnancy
New York: Alan R. Liss 1981 3: 183-187
MissingFormLabel
- 32 Barss V A, Benacerraf B R, Frigoletto F D. Ultrasonographic determination of chorion type in twin gestation. Obstet Gynecol . 1985; 66 779-782
- 33 Hertzberg B S, Kurtz A B, Choi H Y. Significance of membrane thickness in the sonographic evaluation of twin gestations. AJR . 1987; 148 151-153
- 34 Townsend R R, Simpson G F, Filly R A. Membrane thickness in ultrasound prediction of chorionicity of twin gestations. J Ultrasound Med . 1988; 7 327-332
- 35 Winn H N, Gabrielli S, Reece E A, Roberts J S, Salafia C M, Hobbins J C. Ultrasonographic criteria for the prenatal diagnosis of placental chorionicity in twin gestations. Am J Obstet Gynecol . 1989; 161 1540-1542
- 36 D'Alton M E, Dudley D K. The ultrasonographic prediction of chorionicity in twin gestation. Am J Obstet Gynecol . 1989; 160 557-561
- 37 Fineberg H J. The ``twin-peak'' sign: reliable evidence of dichorionic twinning. J Ultrasound Med . 1992; 11 571-577
- 38 Scardo J A, Ellings J M, Newman R B. Prospective determination of chorionicity, amnionicity and zygosity in twin gestations. Am J Obstet Gynecol . 1995; 173 1376-1380
- 39 Stagiannis K D, Sepulveda W, Southwell D, Price D A, Fisk N M. Ultrasonographic measurement of the dividing membrane in twin pregnancy during the second and third trimesters: a reproducible study. Am J Obstet Gynecol . 1995; 173 1546-1550
- 40 Wood S L, St Onge R, Connors G, Elliot P D. Evaluation of the twin peak or lambda sign in determining chorionicity in multiple pregnancy. Obstet Gynecol . 1996; 88 6-9
- 41 Vayssière C F, Nazbanou H, Camus E P, Hillion Y E, Nisand I F. Determination of chorionicity in twin gestations by high-frequency abdominal ultrasonography: counting the layers of the dividing membrane. Am J Obstet Gynecol . 1996; 175 1529-1533
- 42 Monteagudo A, Timor-Trisch I E, Sharma S. Early and simple determination of chorionic and amniotic type in multiple-fetal gestations in the first fourteen weeks by high-frequency transvaginal ultrasonography. Am J Obstet Obstet . 1994; 170 824-829
- 43 Kurtz A D, Wapner R J, Mata J, Johnson A, Morgan P. Twin pregnancies: accuracy of first trimester abdominal US in predicting chorionicity and amnionicity. Radiology . 1992; 185 759-762
- 44 Copperman A M, Kaltenbacher L, Walker B, Sandler B, Bustillo M, Grunfeld L. Early first-trimester ultrasound provides a window through which the chorionicity of twins can be diagnosed in an in vitro fertilization (IVF) population. J Assist Reprod Genet . 1995; 12 693-697
- 45 Sepulveda W, Sebire N J, Hughes K, Obido A, Nicolaides K H. The lambda sign at 10-14 weeks of gestation as a predictor of chorionicity in twin pregnancies. Ultrasound Obstet Gynecol . 1996; 7 421-423
- 46 Hill L M, Chenevey P, Hecker J, Martin J G. Sonographic determination of first trimester twin chorionicity and amnionicity. J Clin Ultrasound . 1996; 24 305-308
- 47 Malinowski W. Very early and simple determination of chorionic and amniotic type in twin gestations by high-frequency transvaginal ultrasonography. Acta Genet Med Gemellol . 1997; 46 167-173
- 48 Sherer D M. First trimester ultrasonography of multiple gestations: a review. Obstet Gynecol Surv . 1998; 53 715-726
- 49 Ecker J L, Filly R A, Zaloudek C, Wright R R, Drexler B, Goldberg J D. Chorionicity inaccurately predicted by early ultrasound: a case report. Prenat Diagn . 1998; 18 485-489
- 50 Bromley B, Benacerraf B. Using the number of yolk sacs to determine amnionicity in the early first trimester monochorionic twins. J Ultrasound Med . 1995; 14 415-419
- 51 Babinszki A, Mukerjee T, Kerenyi T, Berkowitz R L, Copperman A B. Diagnosing amnionicity at 6 weeks of pregnancy with transvaginal three-dimensional ultrasonography: a case report. Fertil Steril . 1998; 71 1161-1164
- 52 Hata T, Aoki S, Miyazaki K, Iwanari O, Sawada K, Tagashira T. Three-dimensional ultrasonographic visualization of multiple pregnancy. Gynecol Obstet Invest . 1998; 46 26-30
- 53 Nicolini U, Poblete A. Single intrauterine death in monochorionic twin pregnancies. Ultrasound Obstet Gynecol . 1999; 14 297-301
- 54 Benirschke K, Kim C K. Multiple pregnancy. N Engl J Med . 1973; 288 1276-1284
- 55 Benson C B, Doubilet P M, Laks M P. Outcome of twin gestations following sonographic demonstration of two heart beats in the first trimester. Ultrasound Obstet Gynecol . 1993; 3 343-345
- 56 Machin G, Bramforth F, Innes M, Minichul K. Some perinatal characteristics of monozygotic twins who are dichorionic. Am J Med Genet . 1995; 55 71-76
- 57 OPCS Mortality Statistics 1992. Perinatal and infant: social and biological factors
England and Wales. London: HMSO Series DH3 1995: 26
MissingFormLabel
- 58 Sebire N J, Snijders R JM, Hughes K, Sepulveda W, Nicolaides K H. The hidden mortality of monochorionic twin pregnancies. Br J Obstet Gynaecol . 1997; 104 1203-1207
- 59 Maier R F, Bialobrezeski B, Gross A, Vogel M, Dudenhausen J W, Obladen M. Acute and chronic fetal hypoxia in monochorionic and dichorionic twins. Obstet Gynecol . 1995; 86 973-977
- 60
Minakami H, Honma Y, Matsubara S, Uchida A, Shiraishi H, Sato I.
Effects of placental chorionicity on outcome in twin pregnancies.
J Reprod Med .
1999;
44
595-600
MissingFormLabel
- 61 Dashe J S, McIntire D D, Santos-Ramos R, Leveno K J. Asymmetric head-to-abdomen circumference and adverse outcome in concordant twin pregnancy. Am J Obstet Gynecol . 2000; 182 S116
- 62 Isada N B, Sorokin Y, Drugan A, Johnson M P, Zador I, Evans M I. First trimester fetal size variation in well-dated multifetal pregnancies. Fetal Diagn Ther . 1992; 7 82-86
- 63 Check J H, Chase J S, Nowoozi K, Goldsmith G, Dietterich C. Evidence that difference in size of fraternal twins may originate during early gestation: a case report. Int J Fertil . 1992; 37 165-166
- 64 Dickey R P, Olar T T, Taylor S N. Incidence and significance of unequal gestational sac diameter or embryo crown-rump length in twin pregnancy. Hum Reprod . 1992; 7 1170-1172
- 65 Ahiron R, Blickstein I. Persistent discordant twin growth following IVF-ET. Acta Genet Med Gemellol . 1993; 42 41-44
- 66 Weissman A, Achiron R, Lipitz S, Blickstein I, Mashiah S. The first trimester growth-discordant twin: an ominous prenatal finding. Obstet Gynecol . 1994; 84 110-114
- 67 Sebire N J, D'Ercole C, Soares W, Nayar R, Nicolaides K H. Intertwin disparity in fetal size in monochorionic and dichorionic pregnancies. Obstet Gynecol . 1998; 91 82-85
- 68 Stefos T, Deter R L, Hill R M, Simon N. Individual growth curve standards in twins: growth in the second trimester. J Clin Ultrasound . 1989; 17 641-646
- 69 Senoo M, Okamura K, Murotsuki J, Yaegashi N, Uehara S, Yajima A. Growth pattern of twins of different chorionicity evaluated by sonographic biometry. Obstet Gynecol . 2000; 95 656-661
- 70 Fraser D, Picard R, Picard E, Leiberman J R. Birth weight discordance, intrauterine growth retardation and perinatal outcomes in twins. J Reprod Med . 1994; 39 504-508
- 71 Hsieh T T, Chang T C, Hsu J J, Chao A. Growth discordancy, birthweight, and neonatal adverse events in third trimester twin gestations. Gynecol Obstet Invest . 1994; 38 36-40
- 72 Snijder J M, Wladimiroff J W. Fetal biometry and outcome in monochorionic versus dichorionic twin pregnancies: a retrospective cross-sectional matched-control study. Ultrasound Med Biol . 1998; 24 197-201
- 73 Danskin F H, Neilson J P. Twin-to-twin transfusion syndrome: what are appropriate diagnostic criteria?. Am J Obstet Gynecol . 1989; 161 365-369
- 74 Charlemaine C, Duyme M, Guis F. Twin differences and similarities of birthweight and term in the French Romulus population. Acta Genet Med Gemellol . 1998; 47 1-12
- 75 Vlietinck R, Derom R, Neale M C. Genetic and environmental variation in the birth weight of twins. Behav Genet . 1989; 19 151-159
- 76 Sebire N J, D'Ercole, Hughes K, Rennie J, Nicolaides K H. Dichorionic twins discordant for intrauterine growth retardation. Arch Dis Child . 1997; 77 F235-F236
- 77 Ananth C, Vintzileos A M, Shen-Schwartz S, Smulian J C, Lai Y L. Standards of birth weight in twin gestations stratified by placental chorionicity. Obstet Gynecol . 1998; 91 917-924
- 78 Gaucherand P, Rudigoz R C, Piacenza J M. Monofetal death in multiple pregnancies: risks for the co-twin, risk factors and obstetrical management. Eur Obstet Gynecol Reprod Biol . 1994; 55 111-115
- 79 Murphy K W. Intrauterine death in a twin: implications for the survivor. In: Ward RH, Whittle M, eds. Multiple Pregnancy
London: RCOG press 1995: 218-231
MissingFormLabel
- 80 Bajoria R, Wee L Y, Anwar S, Ward S. Outcome of twin pregnancies complicated by single intrauterine death in relation to vascular anatomy of the monochorionic placenta. Hum Reprod . 1999; 14 2124-2130
- 81 Okamura K, Murotsuki J, Tanigawara S, Uehara S, Yajima A. Funipuncture for evaluation of hematologic and coagulation indices in the surviving twin following co-twin's death. Obstet Gynecol . 1994; 83 975-978
- 82 Carlson N J, Towers C V. Multiple gestation complicated by the death of one fetus. Obstet Gynecol . 1989; 73 685-689
- 83 Fusi L, Gordon H. Twin pregnancy complicated by single intrauterine death. problems and outcome with conservative management. Br J Obstet Gynaecol . 1990; 97 511-516
- 84 Enbom J A. Twin pregnancy with intrauterine death of one twin. Am J Obstet Gynecol . 1985; 152 424-429
- 85 Benirschke K. Twin placenta in perinatal mortality. NY State J Med . 1961; 61 1499-1508
- 86 Pridjian G, Nugent C E, Barr M. Twin gestation influence of placentation on fetal growth. Am J Obstet Gynecol . 1991; 165 1394-1401
- 87 Prömpeler H J, Madjar H, Klosa W, Du Bois A, Zahradnik H P, Schillinger H, Breckwoldt M. Twin pregnancies with single death. Acta Obstet Gynecol Scand . 1994; 73 205-208
- 88 Hannah J H, Hill J M. Single intrauterine fetal demise in multiple gestation. Obstet Gynecol . 1984; 63 126-130
- 89 Liu S, Benirschke K, Scioscia A L, Mannino F L. Intrauterine death in multiple gestation. Acta Genet Med Gemellol . 1992; 41 5-26
- 90 Gold F, Saliba E, Grangeponte M C, Balliet C, Pourcelot D, Toutain A, Pierre F, Figon A, Body G. Cerebral lesions observed in a twin after the in utero death of the other twin: fetal anoxia-ischemia can be the possible mechanism (3 cases). Arch Fr Pediatr . 1992; 49 529-533
- 91 Lage J M, Vanmarter L J, Mikhail E. Vascular anastomoses in fused, dichorionic twin placentas resulting in twin transfusion syndrome. Placenta . 1989; 10 55-59
- 92 Pezzati M, Cianciulli D, Carbone C. Acute feto-fetal transfusion in dichorionic twins: a clinical case report. Pediatr Med Chir . 1993; 15 305-306
- 93 King A D, Soothill P W, Montemagno R, Young M P, Sams V, Rodeck C H. Twin to twin transfusion in a dichorionic pregnancy without the oligohydramnios-polyhydramnios sequence. Br J Obstet Gynaecol . 1995; 102 334-335
- 94 Molnar-Nadasdy G, Altshuler G. A case of twin transfusion syndrome with dichorionic placentas. J Perinatol . 1996; 16 507-509
- 95 Rodriquez J G, Porter H, Sirrta G M, Soothill P W. Twin to twin transfusion in a dichorionic pregnancy without the oligohydramnios-polyhydramnios sequence. Br J Obstet Gynaecol . 1996; 103 1056
- 96 Cameron A H. The Birmingham twin survey. Proc Royal Soc Med . 1968; 61 229-234
- 97 Phelan M C, Blackburn W R. Vascular anastomoses leading to amelia and cutis aplasia in a dizygotic twin pregnancy. Clin Genet . 1998; 53 126-130
- 98 Van Allen M, Smith D, Shepard T. Twin reversed arterial perfusion (TRAP) sequence: a study of 14 twin pregnancies with acardius. Semin Perinatol . 1983; 7 285-293
- 99 Eberle A M, Levesque D, Vintzileos A M, Egan J FX, Tsapanos V, Salafia C M. Placental pathology in discordant twins. Am J Obstet Gynecol . 1993; 169 931-935
- 100 Bleker O P, Oosting H. Term and postterm twin gestations; placental cause of perinatal mortality. J Reprod Med . 1997; 42 15-18
- 101 Minakami H, Sato I. Reestimating date of delivery in multifetal pregnancies. JAMA . 1996; 275 1432-1434