Twin pregnancy outcome of our clinic: A threeyear follow up

Twin pregnancy outcome of our clinic: A threeyear follow up

Aim: We aimed to present the obstetric and perinatal outcomes of twin pregnancies that were followed up by our clinic, for threeyears.Material and Methods: The twin pregnancies, which were followed up during their whole gestational periods and delivered in ourclinic, from the year 2016 to 2019, were observed retrospectively for their obstetric and perinatal outcomes.Results: 56 twin pregnancies were enrolled in the study, 48 (85.7%) of which were conceived spontaneously, and 8 of which wereconceived with assisted reproductive techniques. 48 (85.7%) of all twins were dichorionic (DC) diamniotic, 7 of them (12.5%) weremonochorionic (MC) diamniotic, and 1 of them ( 1.78%) was MC monoamniotic. Ages of mothers, a gestational week at delivery, wayof delivery, birth weights of newborns, and complications like preterm labor, the discordance of twin pairs, intrauterine fetal demise,twin to twin syndrome (TTTS), and twin anemia- polycythemia sequence were examined. Preterm labor was observed in 22 (39.3%)twin pregnancies, and the discordance rate was 21.4%. In 5 of them (8.9%), TTTS developed. One of the twin pair died in 5 (8.9%) ofall. 1 (1.8%) conjoined twin was observed and delivered at term. Forty-eight of all twin pregnancies (85.7%) delivered by caesariansection, 6 of them (10.71%) by the vaginal route, and 2 of them (3.51%) ended with a miscarriage.Conclusions: Twin pregnancies are high-risk pregnancies when the fetal and maternal outcomes are in concern. Chorionicity is themost important factor effective in perinatal outcomes. Early recognition of the complications, mainly belonging to MC twins, andfrequent antenatal follow up will help to intervene at the correct time and decrease fetal and maternal complication rates.

___

  • 1. National Guideline Alliance (UK).NG137. Twin and Triplet Pregnancy. National Institute for Health and Care Excellence (UK); September 2019.
  • 2. Martin JA, Hamilton BE, Osterman MJ. Three decades of twin births in the United States 1980-2009. NCHS Data Brief. 2012.
  • 3. Young BC, Wylie BJ. Effects of twin gestation on maternal morbidity. Semin Perinatol 2012;36:162–8.
  • 4. American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. ACOG Practice Bulletin No. 144: Multifetal gestations: twin, triplet, and higher-order multifetal pregnancies. Obstet Gynecol 2014;123:1118-32.
  • 5. Glinianaia SV, Rankin J, Khalil A, et al. Prevalence, antenatal management and perinatal outcome of monochorionic monoamniotic twin pregnancy: a collaborative multicenter study in England, 2000- 2013.Ultrasound Obstet Gynecol 2019;53:184-92.
  • 6. Khalil A, Rodgers M, Baschat A, et al. ISUOG Practice Guidelines: role of ultrasound in twin pregnancy. Ultrasound Obstet Gynecol 2016;47:247-63.
  • 7. Dias T, Arcangeli T, Bhide A, et al. First-trimester ultrasound determination of chorionicity in twin pregnancy. Ultrasound Obstet Gynecol 2011;38:530- 2.
  • 8. Johansen ML, Oldenburg A, Rosthøj S, et al. Crown-rump length discordance in the first trimester: a predictor of adverse outcome in twin pregnancies?Ultrasound Obstet Gynecol 2014;43:277-83.
  • 9. Rossi AC, D’Addario V. The efficacy of the Quintero staging system to assess the severity of twin-twin transfusion syndrome treated with laser therapy: a systematic review with meta-analysis.Am J Perinatol 2009;26:537-44.
  • 10. Visser GL, Tollenaar LSA, Bekker V, et al. Leukocyte counts and other hematological values in twin-twin transfusion syndrome and twinanemia-polycythemia sequence. Fetal Diagn Ther 2019:1-6.
  • 11. Andersen AN, Gianaroli L, Nygren KG. Assisted reproductive technology in Europe. Results generated from European registers by ESHRE. Hum Reprod 2004;19:490–503.
  • 12. T.C.Sağlık Bakanlığı’nca 06 Mart 2010-27513 sayılı Resmi Gazete’de yayılanan ‘Üremeye Yardımcı Tedavi Uygulamaları ve Üremeye Yardımcı Tedavi Merkezleri Hakkında Yönetmelik.
  • 13. McLennan AS, Gyamfi-Bannerman C, Ananth CV, et al. The Role of Maternal Age in Twin Pregnancy Outcomes. Am J Obstet Gynecol 2017; 217:80.1–80.8.
  • 14. Gluck O, Mizrachi Y, Bar J, et al. The impact of advanced maternal age on the outcome of twin pregnancies. Arch Gynecol Obstet 2018;297:891-5.
  • 15. Hack KEA, Vereycken MEMS, Torrance HL, et al. Perinatal outcome of monochorionic and dichorionic twins after spontaneous and assisted conception: a retrospective cohort study. Acta Obstet Gynecol Scand 2018;97:717-26.
  • 16. Erkan S, Öcal P, Cepni İ, et al. Spontaneous twin pregnancies versus twin pregnancies conceived with assisted reproductive technologies. Gynecol Obstet Reprod Med 2006;12:23-6.
  • 17. Mackie FL, Morris RK Kilby MD. The prediction, diagnosis, and management of complications in monochorionic twin pregnancies: the OMMIT (Optimal Management of Monochorionic Twins) study.BMC Pregnancy Childbirth 201726;17:153.
  • 18. MONO MONO Working Group. Inpatient vs. outpatient management and timing of delivery of uncomplicated monochorionic monoamniotic twin pregnancy: the MONO MONO study. Ultrasound Obstet Gynecol 2019;53:175-83.
  • 19. Townsend R, D’Antonio F, Sileo FG, et al. Perinatal outcome of monochorionic twin pregnancy complicated by selective fetal growth restriction according to management: systematic review and meta-analysis.Ultrasound Obstet Gynecol 2019;53:36-46.
  • 20. Mackie FL, Morris RK, Kilby MD. The prediction, diagnosis, and management of complications in monochorionic twin pregnancies: the OMMIT (Optimal Management of Monochorionic Twins) study. BMC Pregnancy Childbirth 2017;17:153.
  • 21. Knijnenburg PJC, Slaghekke F, Tollenaar LSA, et al. Incidence of and Risk Factors for Residual Anastomoses in Twin-Twin Transfusion Syndrome Treated with Laser Surgery: A 15-Year Single-Center Experience.Fetal Diagn Ther 2019;45:13-20.
  • 22. Townsend R, Khalil A. Ultrasound surveillance in twin pregnancy: An update for practitioners. Ultrasound 2018;26:193-205.
  • 23. Roberts D, Neilson JP, Kilby MD, et al. Interventions for the treatment of twin-twin transfusion syndrome. Cochrane Database Syst Rev 2014;1:CD002073.
  • 24. Tollenaar LS, Slaghekke F, Middeldorp JM, et al. Twin anemia polycythemia sequence: current views on pathogenesis, diagnostic criteria, perinatal management, and outcome. Twin Res Hum Genet 2016;19:222-33.
  • 25. Slaghekke F, Zhao DP, Middeldorp JM, Klumper FJ, Haak MC, Oepkes D, et al. Antenatal management of twin-twin transfusion syndrome and twin anemiapolycythemia sequence. Expert Rev Hematol 2016;9:815-20.
  • 26. Pagani G, D’Antonio F, Khalil A, et al. Intrafetal laser treatment for twin reversed arterial perfusion sequence: Cohort study and meta-analysis. Ultrasound Obstet Gynecol 2013;42:6-14.
  • 27. Korsakissok M, Groussolles M, Dicky O, et al. Mortality, morbidity and 2-years neurodevelopmental prognosis of twin to twin transfusion syndrome after fetoscopic laser therapy: a prospective, 58 patients cohort study. J Gynecol Obstet Hum Reprod 2018;47:555-60.
  • 28. Peng R, Xie HN, Lin MF, et al. Clinical outcomes after selective fetal reduction of complicated monochorionic twins with radiofrequency ablation and bipolar cord coagulation. Gynecol Obstet Invest 2016;81:552-8.
  • 29. Yucel A, Uygur D. Fetoscopic Laser Coagulation in Twin-Twin Transfusion Syndrome: Case Series. Gynecol Obstet Reprod Med 2018;24:52-5.
  • 30. Lewi L, Jani J, Blickstein I, et al. The outcome of monochorionic diamniotic twin gestations in the era of invasive fetal therapy: a prospective cohort study. Am J Obstet Gynecol 2008;199:514-8.
  • 31. Vieira LA, Warren L, Pan S, et al. Comparing pregnancy outcomes and loss rates in elective twin pregnancy reduction with ongoing twin gestations in a large contemporary cohort. Am J Obstet Gynecol 2019;pii: S0002-9378:30530-7.
  • 32. Proctor LK, Kfouri J, Hirsch L, et al. Association between hypertensive disorders and fetal growth restriction in twin compared with singleton gestations. Am J Obstet Gynecol 2019;pii: S0002-9378:30587-3.
  • 33. Meyer R, Orvieto R, Israel A, et al.Outcomes of singleton versus twin pregnancies in the fifth and sixth decades. Eur J Obstet Gynecol Reprod Biol 2018;231:255-61.
Annals of Medical Research-Cover
  • Yayın Aralığı: Aylık
  • Yayıncı: İnönü Üniversitesi Tıp Fakültesi
Sayıdaki Diğer Makaleler

Effects of Vitamin D on adropine and apoptosis in kidney tissue

Erhan ÖNALAN, Nevzat GÖZEL, Emir DÖNDER, Tuncay KULOĞLU, Selçuk DEMİRCAN, Süleyman AYDIN, Mehmet Hanifi YALÇIN

The effect of perioperative mean arterial pressure and fluid management on postoperative acute kidney injury: Prospective evaluation of 219 coronary artery bypass cases

Türkan NABİYEVA, Sibel Yılmaz FERHATOĞLU, Nihan YAPICI

Analysis of lumbar disc degeneration: 82 cases

Abdurrahman ÇETİN, Murat BALOĞLU, Hüseyin ÖZVEREN

Fall related self efficacy: A significant barrier for physical activity in ambulatory multiple sclerosis patients

Yeliz SALCI, Ayla Fil BALKAN

Quality of life and sleep in diabetes mellitus patients

Mustafa DEMİR

Robot-assisted laparoscopic radical prostatectomy: A single center initial experience

İbrahim KARABULUT, Fatih Kürşat YILMAZER, Ali Haydar YILMAZ, Ercüment KESKİN

Postnatal hydrocortisone therapy for the treatment of bronchopulmonary dysplasia in very low birth weight infants

Fuat Emre CANPOLAT, Mehmet BÜYÜKTİRYAKİ, Evrim Alyamac DİZDAR, Nilufer OKUR, Handan BEZİRGANOĞLU, Fatmanur SARI, Nurdan URAS, Şerife Suna OĞUZ

Comparison of surgery and surgery plus corticosteroid therapy in idiopathic granulomatous mastitis, prospective randomized study

Mehmet PATMANO, Alper AKCAN, Serap DOĞAN, İskender GÜN, Erdoğan SÖZÜER, Abdullah Bahadır ÖZ, Türkmen Bahadır ARIKAN

Inferior alveolar nerve paresthesia due to radicular cyst: A case and review of literature

Mahmut KOĞARAL, Bilal EGE, Aydın KESKİNRÜZGAR, Günay Yapıcı YAVUZ, Abdussamed GEYİK, Bilge Aydın TÜRK

A bioinformatical approach to the pathogenesis of Fragile X premutation carriers

Elif PALA