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Weight discordance and perinatal mortality in monoamniotic twin pregnancy: analysis of MONOMONO, NorSTAMP and STORK multiple‐pregnancy cohorts

Saccone, G; Khalil, A; Thilaganathan, B; Glinianaia, SV; Berghella, V; D'Antonio, F; MONOMONO; NorSTAMP; STORK research collaboratives (2020) Weight discordance and perinatal mortality in monoamniotic twin pregnancy: analysis of MONOMONO, NorSTAMP and STORK multiple‐pregnancy cohorts. Ultrasound Obstet Gynecol, 55 (3). pp. 332-338. ISSN 1469-0705 https://doi.org/10.1002/uog.20357
SGUL Authors: Thilaganathan, Baskaran Khalil, Asma

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Abstract

Objectives The primary objective was to quantify the risk of perinatal mortality in non‐anomalous monochorionic monoamniotic (MCMA) twin pregnancies complicated by birth‐weight (BW) discordance. The secondary objectives were to investigate the effect of inpatient vs outpatient fetal monitoring on the risk of mortality in weight‐discordant MCMA twin pregnancies, and to explore the predictive accuracy of BW discordance for perinatal mortality. Methods This analysis included data on 242 MCMA twin pregnancies (484 fetuses) from three major research collaboratives on twin pregnancy (MONOMONO, STORK and NorSTAMP). The primary outcomes were the risks of intrauterine (IUD), neonatal (NND) and perinatal (PND) death, according to weight discordance at birth from ≥ 10% to ≥ 30%. The secondary outcomes were the association of inpatient vs outpatient fetal monitoring with the risk of mortality in weight‐discordant pregnancies, and the accuracy of BW discordance in predicting mortality. Logistic regression and receiver‐operating‐characteristics‐curve analyses were used to analyze the data. Results The risk of IUD was significantly increased in MCMA twin pregnancies with BW discordance ≥ 10% (odds ratio (OR), 2.2; 95% CI, 1.1–4.4; P = 0.022) and increased up to an OR of 4.4 (95% CI, 1.3–14.4; P = 0.001) in those with BW discordance ≥ 30%. This association remained significant on multivariate logistic regression analysis for BW‐discordance cut‐offs ≥ 20%. However, weight discordance had low predictive accuracy for mortality, with areas under the receiver‐operating‐characteristics curve of 0.60 (95% CI, 0.46–0.73), 0.52 (95% CI, 0.33–0.72) and 0.57 (95% CI, 0.45–0.68) for IUD, NND and PND, respectively. There was no difference in the risk of overall IUD, single IUD, double IUD, NND or PND between pregnancies managed as an inpatient compared with those managed as an outpatient, for any BW‐discordance cut‐off. Conclusions MCMA twin pregnancies with BW discordance are at increased risk of fetal death, signaling a need for increased levels of monitoring. Despite this, the predictive accuracy for mortality is low; thus, detection of BW discordance alone should not trigger intervention, such as iatrogenic delivery. The current data do not demonstrate an advantage of inpatient over outpatient management in these cases.

Item Type: Article
Additional Information: This is the peer reviewed version of the following article: Saccone, G., Khalil, A., Thilaganathan, B., Glinianaia, S.V., Berghella, V., D'Antonio, F. and (2020), Weight discordance and perinatal mortality in monoamniotic twin pregnancy: analysis of MONOMONO, NorSTAMP and STORK multiple‐pregnancy cohorts. Ultrasound Obstet Gynecol, 55: 332-338, which has been published in final form at https://doi.org/10.1002/uog.20357. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Keywords: cesarean delivery, chorionicity, cord accident, cord entanglement, health care, monochorionic, multiple gestation, perinatal death, respiratory distress syndrome, twin pregnancy, MONOMONO, NorSTAMP, STORK research collaboratives, 1114 Paediatrics And Reproductive Medicine, Obstetrics & Reproductive Medicine
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Ultrasound Obstet Gynecol
ISSN: 1469-0705
Language: eng
Dates:
DateEvent
2 March 2020Published
13 February 2020Published Online
20 May 2019Accepted
Publisher License: Publisher's own licence
Projects:
Project IDFunderFunder ID
UNSPECIFIEDBritish Maternal and Fetal Medicine SocietyUNSPECIFIED
UNSPECIFIEDTwins and Multiple Births AssociationUNSPECIFIED
PubMed ID: 31132179
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/110918
Publisher's version: https://doi.org/10.1002/uog.20357

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