TY - JOUR
T1 - Weight discordance and perinatal mortality in monoamniotic twin pregnancy
T2 - analysis of MONOMONO, NorSTAMP and STORK multiple-pregnancy cohorts
AU - for the MONOMONO, NorSTAMP and STORK research collaboratives
AU - Saccone, G.
AU - Khalil, A.
AU - Thilaganathan, B.
AU - Glinianaia, S. V.
AU - Berghella, V.
AU - D'Antonio, F.
AU - Zullo, Fulvio
AU - Locci, Mariavittoria
AU - Guida, Maurizio
AU - Anastasio, Hannah
AU - Ghi, Tullio
AU - Frusca, Tiziana
AU - Dall'Asta, Andrea
AU - Galli, Letizia
AU - Volpe, Nicola
AU - Lanna, Mariano
AU - Faiola, Stefano
AU - Fichera, Anna
AU - Prefumo, Federico
AU - Rizzo, Giuseppe
AU - Arduino, Silvana
AU - Cantanna, Elisabetta
AU - Simonazzi, Giuliana
AU - Seravalli, Viola
AU - Rita Magro-Malosso, Elena
AU - Di Tommaso, Mariarosaria
AU - L. Miller, Jena
AU - A. Baschat, Ahmet
AU - Vitagliano, Amerigo
AU - Visentin, Silvia
AU - Cosmi, Erich
AU - Caissutti, Claudia
AU - Driul, Lorenza
AU - Di Mascio, Daniele
AU - Benedetti Panici, Pierluigi
AU - Vena, Flaminia
AU - Brunelli, Roberto
AU - Ciardulli, Andrea
AU - Schoen, Corina
AU - Suhag, Anju
AU - Maria Gambacorti-Passerini, Zita
AU - Angeles Anaya Baz, Maria
AU - Magoga, Giulia
AU - Busato, Enrico
AU - Filippi, Elisa
AU - José Rodriguez Suárez, María
AU - Gamez Alderete, Francisco
AU - Alonso Ortuno, Paula
AU - Vendola, Marianne
AU - Navaneethan, Preethi
N1 - Funding Information:
S.V.G. was funded by a 2015–2016 bursary from the British Maternal & Fetal Medicine Society (BMFMS) and the Twins and Multiple Births Association (TAMBA).
Publisher Copyright:
Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - 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.
AB - 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.
KW - Cesarean delivery
KW - chorionicity
KW - cord accident
KW - cord entanglement
KW - healthcare
KW - monochorionic
KW - multiple gestation
KW - perinatal death
KW - respiratory distress syndrome
KW - twin pregnancy
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U2 - 10.1002/uog.20357
DO - 10.1002/uog.20357
M3 - Article
C2 - 31132179
AN - SCOPUS:85079455909
SN - 0960-7692
VL - 55
SP - 332
EP - 338
JO - Ultrasound in Obstetrics and Gynecology
JF - Ultrasound in Obstetrics and Gynecology
IS - 3
ER -